“The cost-effectiveness of psychotherapy for the major psychiatric diagnoses.” By Susan G. Lazar; published 2014 in Psychodynamic Psychiatry.

• ABSTRACT: Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.

“Costs and benefits of long-term psychoanalytic therapy: changes in health care use and work impairment.” By Saskia de Maat, Frans Philipszoon, Robert Schoevers, Jack Dekker, and Frans De Jonghe; published 2007 in the Harvard Review of Psychiatry.

• ABRIDGED ABSTRACT: Objective: systematic review regarding the effectiveness of long-term psychoanalytic therapy (LPT) on health care use and work impairment in adult outpatients. Conclusions: our data suggest that LPT substantially reduces health care use and sick leave. The benefits seem to endure for years after termination and reach the point of counterbalancing the costs of treatment approximately three years after treatment termination.

“Expanding the evidence base for the cost-effectiveness of long-term psychoanalytic treatment.” By Jolien Zevalkink and Caspar C Berghout; published 2006 in the Journal of the American Psychoanalytic Association.

• ABSTRACT: unavailable.

“Medical cost offset: A review of the impact of psychological interventions on medical utilization over the past three decades.” By Jeremy A. Chiles, Lambert Michael, and Arlin L. Hatch; published 2002 in Clinical Psychology: Science and Practice.

• ABSTRACT: This meta-analytic review addresses a number of cost-offset questions: (1) is there a measurable cost-offset effect in the extant literature? (2) are there particular psychological interventions or specific treatment settings that have an increased offset effect? (3) is there a demonstrated difference in the offset effect between impatient hospital offset studies where medical utilization is only a piece in a much larger psychological puzzle? (4) are psychological interventions cost-effective in terms of "offset" savings exceeding the cost of the interventions? (5) if an offset effect exists in the literature, to what mechanism of change can this reduction in medical costs, inpatient length of stay, or outpatient medical visit be attributed? Analyses are based on a pool of 91 studies (published between 1967-1997) with 128 different treatment groups, identified through a computer search using the Psychlit and Medline databases. Effect size and percentage change analyses across studies yielded positive findings pertaining to the cost offset of psychological interventions used among a wide variety of patients. Specifically, health psychology and behavioral medicine techniques in the context of surgery offer consistent support for the cost offset effect.

“Psychotherapy for personality disorders.” By Katherine L. Dixon-Gordon, Brianna J. Turner, and Alexander L. Chapman; published 2011 in International Review of Psychiatry.

• ABSTRACT: Personality disorders are widely prevalent among those seeking mental health services, resulting in substantial distress and a heavy burden on public assistance and health resources. We conducted a qualitative review of randomized controlled trials (RCTs) of psychosocial interventions for personality disorders. Articles were identified through searches of electronic databases and classified based on the focus of the psychological intervention. Data regarding treatment, participants and outcomes were identified. We identified 33 RCTs that evaluated the efficacy of various psychosocial treatments. Of these studies, 19 focused on treatment of borderline personality disorder, and suggested that there are several efficacious treatments and one well-established treatment for this disorder. In contrast, only five RCTs examined the efficacy of treatments for Cluster C personality disorders, and no RCTs tested the efficacy of treatments for Cluster A personality disorders. Although other personality disorders, especially Cluster A, place heavy demands on public assistance, and in spite of recommendations that psychosocial interventions should be the first line of treatment for these disorders, our review underscored the dearth of treatment research for many of these personality disorders. We highlight some obstacles to such research and suggest directions for future research.

Psychotherapy is worth it: A comprehensive review of its cost-effectiveness. By Susan G. Lazar; published 2010 by American Psychiatric Publishing, Inc.

• OVERVIEW: In Psychotherapy is worth it: A comprehensive review of its cost-effectiveness, edited by Susan G. Lazar, M.D., and co-authored with members of the Committee on Psychotherapy of the Group for the Advancement of Psychiatry, surveys the medical, psychiatric and psychological literature from 1984 to 2007 that is relevant to the cost-effectiveness of all kinds of psychotherapy. The volume explores the cost of providing psychotherapy in relation to its impact both on health and on the costs to society of psychiatric illness and related conditions.