Cost-utility of individual internet-based and face-to-face Mindfulness-Based Cognitive Therapy compared to Treatment As Usual in reducing psychological distress in cancer patients
Menée aux Pays-Bas auprès de 245 patients atteints de divers cancers, cette étude compare le rapport coût-efficacité, pour réduire la détresse psychologique, des thérapies habituelles (traitements souhaités par les patients) et des psychothérapies basées sur le concept de la pleine conscience, dispensées en groupe en face à face ou individuellement par internet
Objective : It was previously determined that group‐based face‐to‐face Mindfulness‐based Cognitive Therapy (MBCT) and individual internet‐based MBCT (eMBCT) are equally efficacious compared to treatment as usual (TAU) in reducing psychological distress. In this study the incremental cost‐utility of both interventions compared to TAU was assessed. Methods : This cost‐effectiveness study included 245 self‐referred heterogeneous cancer patients with psychological distress who were randomized to MBCT, eMBCT or TAU. Healthcare costs and (informal) work‐related productivity losses were assessed by interview. Outcomes were expressed in EuroQol‐5D‐3L utility scores and Quality Adjusted Life Years (QALY). An economic evaluation with a time‐horizon of 3 months was conducted from the societal perspective in the intention‐to‐treat sample. In addition, secondary explorative analyses of costs and quality of life during the 9 month‐follow‐up were conducted based on linear extrapolation of TAU. Results : Paid work‐related productivity losses and societal costs were lower in both intervention conditions compared to TAU during the 3‐month intervention period. Moreover, quality of life (utility scores) improved in eMBCT versus TAU (Cohen's d: .54) and MBCT versus TAU (.53). At a willingness to pay of €20000 per QALY, the mean incremental net monetary benefit was €1916 (SD=€783) in eMBCT and €2365 (SD=€796) in MBCT versus TAU. Exploration of costs demonstrated an equal pattern of eMBCT and MBCT being superior to TAU. Quality of life at 9 months follow‐up remained improved in both interventions. Conclusions : Results indicate that eMBCT and MBCT are cost‐saving treatments whilst simultaneously improving quality of life for distressed cancer patients.