Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: A cost-effectiveness study
SourceJournal of Psychosomatic Research, 74, 3, (2013), pp. 197-205
Article / Letter to editor
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Primary and Community Care
Epidemiology, Biostatistics & HTA
Journal of Psychosomatic Research
SubjectDCN PAC - Perception action and control; NCEBP 2: Evaluation of complex medical interventions; NCEBP 7: Effective primary care and public health; NCEBP 9: Mental health; ONCOL 4: Quality of Care
OBJECTIVE: Our aim was to assess cost-effectiveness of mindfulness-based cognitive therapy (MBCT) compared with enhanced usual care (EUC) in treating patients with persistent medically unexplained symptoms(MUS). METHODS: A full economic evaluation with a one year time horizon was performed from a societal perspective. Costs were assessed by prospective cost diaries. Health-related Quality of Life was measured using SF-6D. Outcomes were costs per Quality-Adjusted Life Year (QALY). Bootstrap simulations were performed to obtain mean costs, QALY scores and incremental cost-effectiveness ratios (ICERs). RESULTS: MBCT participants (n=55) had lower hospital costs and higher mental health care costs than patients who received EUC (n=41). Mean bootstrapped costs for MBCT were euro6269, and euro5617 for EUC (95% uncertainty interval for difference: -euro1576; euro2955). QALYs were 0.674 for MBCT and 0.663 for EUC. MBCT was on average more effective and more costly than EUC, resulting in an ICER of euro56,637 per QALY gained. At a willingness to pay of euro80,000 per QALY, the probability that MBCT is cost-effective is 57%. CONCLUSION: Total costs were not statistically significantly different between MBCT and EUC. However, MBCT seemed to cause a shift in the use of health care resources as mental health care costs were higher and hospital care costs lower in the MBCT condition. Due to the higher drop-out in the EUC condition the cost-effectiveness of MBCT might have been underestimated. The shift in health care use might lead to more effective care for patients with persistent MUS. The longer-term impact of MBCT for patients with persistent MUS needs to be further studied.
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