Economic Evaluation Alongside a Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Healthy Adults

Abstract

Maki Nagaoka,1,2 Akihiro Koreki,1– 3 Teppei Kosugi,4 Akira Ninomiya,1,2 Masaru Mimura,2,5 Mitsuhiro Sado1,2,6 1Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku-ku, Japan; 2Mindfulness & Stress Research Center, Keio University, Shinjuku-ku, Japan; 3Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan; 4Department of Psychiatry, Gunma Hospital, Takasaki, Japan; 5Keio University Centre for Preventive Medicine, Keio University, Shinjuku-ku, Japan; 6Keio University Health Center, Keio University, Yokohama City, JapanCorrespondence: Mitsuhiro Sado, Keio University Health Center, Keio University, 4-1-1 Hiyoshi, Kouhoku-ku, Yokohama City, Kanagawa, 223-8521, Japan, Tel [phone], Fax [phone], Email [email protected]: This study aimed to conduct an economic evaluation of mindfulness-based cognitive therapy (MBCT) in healthy participants by performing cost-utility analysis (CUA) and cost-benefit analysis (CBA).Patients and Methods: CUA was carried out from a healthcare sector perspective and CBA was from the employer’s perspective in parallel with a randomized controlled trial. Of the 90 healthy participants, 50 met the inclusion criteria and were randomized to the MBCT group (n = 25) or wait-list control group (n = 25). In the CUA, intervention costs and healthcare costs were included, while the mean difference in the change in quality-adjusted life years (QALYs) between the baseline and 16-week follow-up was used as an indicator of effect. Incremental cost-effectiveness ratio (ICER) was produced, and uncertainty was addressed using non-parametric bootstrapping with 5000 replications. In the CBA, the change in productivity losses was reflected as a benefit, while the costs included intervention and healthcare costs. The net monetary benefit was calculated, and uncertainty was handled with 5000 bootstrapping. Healthcare costs were measured with the self-report Health Service Use Inventory. The purchasing power parity in 2019 was used for currency conversion.Results: In the CUA, incremental costs and QALYs were estimated at JPY 19,700 (USD 189) and 0.011, respectively. The ICER then became JPY 1,799,435 (USD 17,252). The probability of MBCT being cost-effective was 92.2% at the threshold of 30,000 UK pounds per QALY. The CBA revealed that MBCT resulted in increased costs (JPY 24,180) and improved work productivity (JPY 130,640), with a net monetary benefit of JPY 106,460 (USD 1021). The probability of the net monetary benefit being positive was 69.6%.Conclusion: The results suggested that MBCT may be more cost-effective from a healthcare sector perspective and may be cost-beneficial from the employer’s perspective.Keywords: mindfulness, healthy individuals, cost-effectiveness, MBCT

Keywords

• mindfulness
• healthy individuals
• cost-effectiveness
• mbct