King's College London

Research portal

Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations and expert commentary.

Research output: Contribution to journalArticlepeer-review

Joseph Botham, Amy Clarke, Thomas Steare, Ruth Stuart, Sian Oram, Brynmor Lloyd-Evans, Tamar Jeynes, Eva Broeckelmann, Mike Crawford, Sonia Johnson, Alan Simpson, Paul McCrone

Documents

  • Economic evaluation review, revised (clean)

    Economic_evaluation_review_revised_clean_.docx, 207 KB, application/vnd.openxmlformats-officedocument.wordprocessingml.document

    Uploaded date:13 Nov 2021

    Version:Accepted author manuscript

King's Authors

Abstract

Background
Diagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources.

Aims
To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.

Method
Systematic review (PRESPERO #: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement.

Results
Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.

Conclusion
Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. We The strongest evidence was for Dialectical Behavioural Therapy with all three identified studies indicating it is likely to be cost-effective in community settings compared to treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454