Abstract

Objective

Previous studies have established a connection between therapy and healthcare cost: an increase in cost prior to therapy and a maintained decrease post therapy. There is, however, a lack of studies examining the combined effects of psychotherapy and pharmacotherapy on healthcare cost.

Method

Healthcare cost was examined quarterly in 1,213 patients (28,776 observations) in a naturalistic longitudinal design. Psychotherapy only was compared to combined treatment and to an addition of psychotherapy to preexisting pharmacotherapy. The comparisons were conducted with a multilevel piecewise model (LMLM) computed for three phases: pre-, during-, and post-therapy.

Results

Significant interactions were found between the contrast comparing preexisting pharmacotherapy to the during-psychotherapy and no-pharmacotherapy groups and the three piecewise variables. The pre-therapy increase was larger for the preexisting-pharmacotherapy group than for the other groups. The during-therapy decrease was larger for the preexisting-pharmacotherapy group than for the other groups. In the post-therapy period, the increase was significant only for the prior–psychiatric-medication group.

Conclusions

Preexisting psychotropic treatment along with an increase in healthcare expenditure may serve as an indication of the need for additional psychotherapy treatment.

中文翻译：

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心理动力学心理治疗和药物治疗对医疗成本的综合影响

摘要

客观的

以前的研究已经建立了治疗和医疗保健成本之间的联系：治疗前的成本增加和治疗后的持续下降。然而，缺乏研究检查心理治疗和药物治疗对医疗保健成本的综合影响。

方法

在自然纵向设计中，每季度检查 1,213 名患者（28,776 次观察）的医疗保健费用。仅将心理治疗与联合治疗进行比较，并将心理治疗与现有药物治疗相比较。比较是通过计算三个阶段的多级分段模型 (LMLM) 进行的：治疗前、治疗期间和治疗后。

结果

在比较预先存在的药物治疗与心理治疗期间和非药物治疗组的对比与三个分段变量之间发现了显着的相互作用。预先存在的药物治疗组的治疗前增加大于其他组。预先存在的药物治疗组的治疗期间下降幅度大于其他组。在治疗后期间，仅在先前的精神科药物组中增加显着。

结论

预先存在的精神药物治疗以及医疗保健支出的增加可能表明需要额外的心理治疗。