PMC:5332029 / 7278-15075 JSONTXT

{"project":"2_test","denotations":[{"id":"28249032-19621070-91797204","span":{"begin":194,"end":196},"obj":"19621070"},{"id":"28249032-15921055-91797205","span":{"begin":2544,"end":2546},"obj":"15921055"},{"id":"28249032-27075444-91797206","span":{"begin":2547,"end":2549},"obj":"27075444"},{"id":"28249032-15921055-91797207","span":{"begin":3209,"end":3211},"obj":"15921055"},{"id":"28249032-15921055-91797208","span":{"begin":3413,"end":3415},"obj":"15921055"},{"id":"28249032-15921065-91797209","span":{"begin":5352,"end":5354},"obj":"15921065"},{"id":"28249032-21195251-91797210","span":{"begin":6043,"end":6044},"obj":"21195251"}],"text":"Materials and methods\n\nProtocol and registration\nThis review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Statement for Reporting Systematic Reviews [19] and additional guidelines for conducting and reporting systematic reviews [20]. The protocol was registered by the International Prospective Register of Systematic Reviews (registration number: CRD42016037305).\n\nData sources\nLiterature was searched for relevant articles published up to December 2015 using the following online databases: Psychological and Behavioural Sciences, PsychInfo, Scopus, Medline, Web of Science and PubMed. Search terms used for each database included the following: Borderline Personality Disorder OR Personality Disorder AND cost OR cost analysis OR cost benefit OR cost effectiveness OR economic analysis OR (burden AND (society OR community OR individual OR carer OR carers)). This search identified papers directly related to the research questions.\n\nStudy selection\nThe eligibility of the studies was assessed in two steps. First titles and abstracts were screened. Subsequently, articles considered as relevant were obtained and the full text was screened. All original studies reporting cost or cost-effectiveness data of BPD were included.\nStudies were eligible for further consideration in this review if they related to the costs or benefits of interventions for BPD (specifically cost or benefit to the individual, carer or family, or society either through direct (e.g. medical) or indirect (e.g. loss of productivity) costs or benefits. Studies were excluded if they were not in English or German, or did not publish original empirical data (e.g. newspaper articles, reviews, commentaries and editorials). Records identified by the searching process were screened by two authors (DM, AM) and checked by another (BG).\n\nData extraction and risk of bias\nTwo authors (DM and AM) extracted data from the included studies, which was then independently reviewed by another author (BG). This author was blind to prestige factors, including authors, institutions, journal titles, and publishers. The authors compared their findings and discrepancies were discussed and resolved to reach a consensus.\nData extracted included: country of publication, cost year, study sample characteristics (number of participants, age, gender, types of treatment compared), cost (per population and per patient), and if stated, type of economic evaluation.\nTwo categories of costs can be distinguished: direct and indirect costs; [21,22]. Direct costs include all treatment costs that arise directly from medical care. These include items such as the cost of psychiatric inpatient and outpatient care, psychological, rehabilitation, medication, or emergency room treatments. Indirect costs cover all costs that occur secondary to the disease. These include items such as production losses and sickness benefit payments due to days absent at work, as well as years lost due to mortality. In addition, the total costs (either indirect or direct) associated with the delivery of the intervention (intervention costs) were also presented.\nFor the purpose of this review, type of economic evaluation [21], was described and defined as follows:\nFull economic evaluations. A full economic evaluation does not only compare costs of at least two interventions but also their consequences (outcomes, effects) [21]. Effects can be measured in natural units (life years gained, parasuicide events avoided, artificial units (quality-adjusted life years [QALY] or disability-adjusted life years [DALY]) or monetary units measured by techniques like willingness-to-pay experiments. Depending on the effect measure employed, full economic evaluations are called cost-effectiveness analyses (natural units), cost-utility analyses (utility measures) or cost-benefit analyses (outcomes valued monetarily).\nPartial economic evaluations. Health economic studies considered to be partial economic evaluations do not make explicit comparisons between alternative interventions in terms of both costs (resource use) and consequences (effects). In partial economic evaluations only the costs of at least two alternatives are compared (i.e. cost analyses, cost-description studies and cost-outcome descriptions). Partial evaluations can be useful in that they can provide elements of information for a full evaluation and help answer questions not related to efficiency.\nWhilst the methodologies of full economic evaluations and partical economic evaluations are distinct from each other, both types of economic evaluations were included for the purposes of our review. Debate exists as to whether the information derived from partial economic evaluations are of the same scientific value and usefulness as the information derived by full economic evaluations, nevertheless, including both types of economic evaluations will contribute useful evidence to an understanding of economic aspects of interventions.\n\nQuality assessment\nQuality assessment of the studies included was performed by means of the Consensus on Health Economic Criteria (CHEC) checklist. The CHEC-list has been developed using a Delphi method (three Delphi rounds; 23 international experts). The CHEC-list comprehends 19 criteria formulated as a question for answering either by \"yes\" or \"no\" [23].\nThe results of the quality assessment are displayed as percentage of studies fulfilling each criterion.\n\nCost-offset analysis\nThe focus of this review is on costing issues associated with the provision of interventions for the treatment of BPD, including costs, cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to the intervention provided). Cost offsets originate from the use of mental health services and related costs before, during and after (if applicable) a specific intervention. Interventions included were recognised psychological treatments that have separately been shown to have clinical effectiveness and therefore an evidence-base [9].Therefore data was extracted based on cost alone, without further consideration of clinical effectiveness as this had been separately established and is outside the scope of this review.\n\nCost offset PT\nThe cost offset of psychotherapeutic interventions (PT) (Cost offset PT) was calculated by subtracting the total costs after the intervention provided from the total costs before the start of the intervention (i.e. pre-post differences in healthcare costs).\n\nCost offset PT vs. TAU\nThe cost offset of a psychotherapeutic intervention PT vs. TAU (Cost offset PT vs. TAU) represents the difference in total costs after the intervention is provided compared to cost related to the provision of treatment as usual (TAU) (i.e. post- difference in healthcare cost related to PT vs. TAU).\nIn order to assess the costs and cost offsets, and to present a financial evaluation, we applied present-day financial costing standards to the data. Cost data were inflated and converted to 2015 US-$ purchasing power parities (PPP) to ensure comparability of the data [24].\nIf an included study did not report the cost year, the year in which the study was accepted for publication was used as a proxy. To further ensure comparability of the data, costs per patient were calculated if costs data related to groups or a population. Subsequently, if the time horizon chosen in the study was less or more than one year, costs were converted to one year costs.\nDue to the variation in sample size, means weighted for sample size were calculated and reported when presenting the overall cost offset of PT and the overall cost offset of PT vs TAU of all the economic evaluations identified in this review, and where appropriate, compared using independent samples t test."}