Cost-effectiveness of a mentalisation-based treatment for antisocial personality disorder in males convicted of an offence on community probation in England and Wales: Multicentre, assessor-blind randomised controlled trial

Barbara Barrett, Elizabeth Simes, Karen Yirmiya, James M S Wason, Alison Frater, Angus Cameron, Stephen Butler, Zoe Hoare, Mary McMurran, Paul Moran, Mike Crawford, Stephen Pilling, Elizabeth Allison, Jessica Yakeley, Anthony Bateman and Peter Fonagy

PLOS ONE, 2026, vol. 21, issue 7, 1-14

Abstract: This study addresses a critical gap in the evidence base for cost-effective psychological interventions for antisocial personality disorder (ASPD) in forensic settings by presenting a full trial-based economic evaluation of mentalisation-based treatment plus probation as usual (MBT-ASPD + PAU), compared to PAU alone, for males with ASPD convicted of an offence in England and Wales. The economic evaluation adopted a societal perspective, incorporating costs to health care, the criminal justice system, and the wider societal impact of offending. Outcomes were assessed 24 months post-randomisation. The primary cost–utility analysis compared costs with quality-adjusted life years (QALYs) derived from the EQ-5D-5L, while a secondary cost-effectiveness analysis compared costs with aggression outcomes measured by the Overt Aggression Scale – Modified (OAS-M). Although missing data limited definitive conclusions regarding service use, available data suggest that participants in the PAU group spent more time in custody than those in the MBT-ASPD + PAU group. Utility scores and quality of life showed minimal variation over follow-up, with no significant differences between groups. Overall costs were lower in the MBT-ASPD + PAU group, though not statistically significant. Over the 24-month period, MBT-ASPD + PAU was associated with both reduced costs and lower aggression (as reflected in OAS-M scores), indicating that each unit reduction in aggression yielded a cost saving of approximately £93. For QALYs, MBT-ASPD + PAU appeared cost-effective compared to PAU across all values a decision-maker may be willing to pay for improvements in outcome. These findings provide preliminary evidence for the potential economic value of MBT-ASPD + PAU in a forensic ASPD population, particularly in relation to aggression reduction and the associated cost savings.Trial registrationThis trial is registered with ISRCTN (ISRCTN 32309003).

Date: 2026
References: Add references at CitEc
Citations:

Downloads: (external link)
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0352865 (text/html)
https://journals.plos.org/plosone/article/file?id= ... 52865&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0352865

DOI: 10.1371/journal.pone.0352865

Access Statistics for this article

More articles in PLOS ONE from Public Library of Science
Bibliographic data for series maintained by plosone ().