International Journal of Technology Assessment in Health Care


A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy

Caspar C. Berghouta1, Jolien Zevalkinka2 and Leona Hakkaart-van Roijena3

a1 Netherlands Psychoanalytic Institute and VU University

a2 Netherlands Psychoanalytic Institute and Radboud University

a3 Erasmus Medical Center


Objectives: Despite the considerable and growing body of research about the clinical effectiveness of long-term psychoanalytic treatment, relatively little attention has been paid to economic evaluations, particularly with reference to the broader range of societal effects. In this cost-utility study, we examined the incremental cost-effectiveness ratio (ICER) of psychoanalysis versus psychoanalytic psychotherapy.

Methods: Incremental costs and effects were estimated by means of cross-sectional measurements in a cohort design (psychoanalysis, n = 78; psychoanalytic psychotherapy, n = 104). Quality-adjusted life-years (QALYs) were estimated for each treatment strategy using the SF-6D. Total costs were calculated from a societal perspective (treatment costs plus other societal costs) and discounted at 4 percent.

Results: Psychoanalysis was more costly than psychoanalytic psychotherapy, but also more effective from a health-related quality of life perspective. The ICER—that is, the extra costs to gain one additional QALY by delivering psychoanalysis instead of psychoanalytic psychotherapy—was estimated at €52,384 per QALY gained.

Conclusions: Our findings show that the cost-utility ratio of psychoanalysis relative to psychoanalytic psychotherapy is within an acceptable range. More research is needed to find out whether cost-utility ratios vary with different types of patients. We also encourage cost-utility analyses comparing psychoanalytic treatment to other forms of (long-term) treatment.


The authors gratefully acknowledge Dr. M.W. Katzko and Dr. C.A.M. Bouwmans for assistance with data analyses. This project was supported by the Netherlands ZonMw Grant 945–04-414.