Cost Implications of Treatment Non-Completion in a Forensic Personality Disorder Service

Criminal Behaviour and Mental Health, 2013

16 Pages Posted: 2 Aug 2013

See all articles by Christopher James Sampson

Christopher James Sampson

The Office of Health Economics

Marilyn James

University of Nottingham

Nick Huband

Independent

Steve Geelan

Independent

Mary McMurran

University of Nottingham

Date Written: July 23, 2013

Abstract

Background: A high proportion of individuals admitted to specialist secure hospital services for treatment of personality disorder do not complete treatment. Non-completion has been associated with poorer treatment outcomes and increased rates of recidivism and hospital readmission, when compared with individuals who do complete treatment or who do not receive treatment at all.

Aims: In this study, we sought to determine the economic consequences of non-completion of treatment, using case study data from a secure hospital sample. Both health and criminal justice service perspectives were taken into account.

Methods: Data were collected from a medium secure hospital personality disorder unit. A probabilistic decision-analytic model was constructed, using a Markov cohort simulation with 10,000 iterations. The expected cost differential between those who do and those who do not complete treatment was estimated, as was the probability of a cost differential over a 10-year post-admission time horizon.

Results: On average, in the first 10 years following admission, those who do not complete treatment go on to incur £52,000 more in costs to the National Health Service and criminal justice system than those who complete treatment. The model estimates that the probability that non-completers incur greater costs than completers is 78%.

Conclusion: It is possible that an improvement in treatment completion rates in secure hospital personality disorder units would lead to some cost savings. This might be achievable through better selection into treatment or improved strategies for engagement and retention. Our study highlights a financial cost to society of individuals discharged from secure hospital care when incompletely treated. We suggest that it could, therefore, be useful for secure hospitals to introduce routine monitoring of treatment completion.

Keywords: personality disorder, treatment completion, Markov model

JEL Classification: I19, K49

Suggested Citation

Sampson, Christopher James and James, Marilyn and Huband, Nick and Geelan, Steve and McMurran, Mary, Cost Implications of Treatment Non-Completion in a Forensic Personality Disorder Service (July 23, 2013). Criminal Behaviour and Mental Health, 2013, Available at SSRN: https://ssrn.com/abstract=2304608

Christopher James Sampson (Contact Author)

The Office of Health Economics ( email )

12 Whitehall
London, SW1A 2DY
United Kingdom
02077478866 (Phone)

Marilyn James

University of Nottingham ( email )

University Park
Nottingham, NG8 1BB
United Kingdom

Nick Huband

Independent ( email )

Steve Geelan

Independent ( email )

Mary McMurran

University of Nottingham ( email )

University Park
Nottingham, NG8 1BB
United Kingdom

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