Costs and benefits of long-term psychoanalytic therapy: changes in health care use and work impairment.

Objective: systematic review regarding the effectiveness of long-term psychoanalytic therapy (LPT) on health care use and work impairment in adult outpatients.

Method: a systematic search for studies published between 1970 and 2005. Calculation of the weighted mean changes between pretreatment and treatment termination, and between pretreatment and follow-up. The findings are translated into financial terms, and the costs of treatment are balanced against the financial gains.

Results: seven studies (n = 861) met all the inclusion and none of the exclusion criteria. The mean cost of LPT per patient was 20,900 Euro. During the year preceding treatment termination and the year preceding mean follow-up (2.9 years), the average reduction was 85% and 59%, respectively, in the number of hospital days; 54% and 56%, respectively, in the number of medical consultations; 70% and 19%, respectively, in the number of medication users, and 61% and 67% in days of sick leave. Health care use and sick-leave costs fell by an average of 5,584 Euro , or 66%, between the year preceding the start of psychotherapy and the year preceding treatment termination. At mean follow-up (2.9 years) these costs reductions were still apparent, as the reduction was 5,372 Euro, or 64%, in the year preceding follow-up. The break-even point for benefits and treatment costs was approximately three years after treatment termination. The reduction in work impairment appears to be the main factor (65% to 75%) in these positive results.

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.