Mindfulness-based cognitive therapy for recurrent major depression: A 'best buy' for health care?
Study Goal
The researchers aimed to evaluate the health economic properties of mindfulness-based cognitive therapy (MBCT) in reducing depressive relapse/recurrence over a 2-year follow-up period.
Results Summary
MBCT participants had significantly fewer major depressive episode days compared to controls (31 vs. 55 days). From a whole-of-society perspective, MBCT demonstrated reduced costs and health gains, with an incremental gain per disability-adjusted life year of AUD83,744 and annual cost savings of AUD143,511 in specialist care.
Population
Non-depressed adults with a history of three or more major depressive episodes.
Effective Dosage
Not specified
Duration
2 years
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
mindfulness-based cognitive therapy + depressive relapse active monitoring | decrease | major depressive episode days | non-depressed adults with a history of three or more major depressive episodes | 31 days vs 55 days in controls | had significantly less | #1 |
mindfulness-based cognitive therapy | decrease | costs and health gains | patients receiving usual care from all sectors of the health-care system | reduced costs, demonstrable health gains | demonstrated dominance | #2 |
mindfulness-based cognitive therapy | increase | disability-adjusted life year | people in specialist care | AUD83,744 net benefit | incremental gain per disability-adjusted life year | #3 |
mindfulness-based cognitive therapy | decrease | costs | people in specialist care | AUD143,511 | overall annual cost saving | #4 |
OBJECTIVE: While mindfulness-based cognitive therapy is effective in reducing depressive relapse/recurrence, relatively little is known about its health economic properties. We describe the health economic properties of mindfulness-based cognitive therapy in relation to its impact on depressive relapse/recurrence over 2 years of follow-up. METHOD: Non-depressed adults with a history of three or more major depressive episodes were randomised to mindfulness-based cognitive therapy + depressive relapse active monitoring (n = 101) or control (depressive relapse active monitoring alone) (n = 102) and followed up for 2 years. Structured self-report instruments for service use and absenteeism provided cost data items for health economic analyses. Treatment utility, expressed as disability-adjusted life years, was calculated by adjusting the number of days an individual was depressed by the relevant International Classification of Diseases 12-month severity of depression disability weight from the Global Burden of Disease 2010. Intention-to-treat analysis assessed the incremental cost-utility ratios of the interventions across mental health care, all of health-care and whole-of-society perspectives. Per protocol and site of usual care subgroup analyses were also conducted. Probabilistic uncertainty analysis was completed using cost-utility acceptability curves. RESULTS: Mindfulness-based cognitive therapy participants had significantly less major depressive episode days compared to controls, as supported by the differential distributions of major depressive episode days (modelled as Poisson, p < 0.001). Average major depressive episode days were consistently less in the mindfulness-based cognitive therapy group compared to controls, e.g., 31 and 55 days, respectively. From a whole-of-society perspective, analyses of patients receiving usual care from all sectors of the health-care system demonstrated dominance (reduced costs, demonstrable health gains). From a mental health-care perspective, the incremental gain per disability-adjusted life year for mindfulness-based cognitive therapy was AUD83,744 net benefit, with an overall annual cost saving of AUD143,511 for people in specialist care. CONCLUSION: Mindfulness-based cognitive therapy demonstrated very good health economic properties lending weight to the consideration of mindfulness-based cognitive therapy provision as a good buy within health-care delivery.