Cost-effectiveness analysis of mindfulness-based cognitive therapy in patients with anxiety disorders in secondary mental health care settings alongside a randomized controlled trial.

Autor:	Sado M; Keio University Health Center, Tokyo, Japan.; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan., Koreki A; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan.; Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan., Ninomiya A; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan., Kurata C; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan., Park S; Keio University Mindfulness and Stress Research Center, Tokyo, Japan.; Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan., Fujisawa D; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan.; Division of Patient Safety, Keio University Hospital, Tokyo, Japan., Kosugi T; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan., Nagaoka M; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan., Nakagawa A; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan., Mimura M; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.; Keio University Mindfulness and Stress Research Center, Tokyo, Japan.; Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan.
Jazyk:	angličtina
Zdroj:	Frontiers in psychiatry [Front Psychiatry] 2024 Oct 25; Vol. 15, pp. 1391786. Date of Electronic Publication: 2024 Oct 25 (Print Publication: 2024).
DOI:	10.3389/fpsyt.2024.1391786
Abstrakt:	Introduction: Anxiety disorder is one of the most prevalent mental disorders. Mindfulness-based cognitive therapy (MBCT) is effective for treating anxiety disorders. However, no studies have investigated the cost-effectiveness of MBCT for anxiety disorders. We aimed to conduct a cost-effectiveness analysis alongside a randomized controlled trial (RCT) to clarify the cost-effectiveness of MBCT for anxiety disorders. Methods: A cost-effectiveness analysis alongside an RCT was conducted for 8 weeks in 40 patients with anxiety disorders at a university hospital. Patients (1) aged 20-75 years; (2) who were diagnosed with panic disorder/agoraphobia or social anxiety disorder based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria; and (3) who provided written consent were analyzed. The participants were allocated randomly (1:1 ratio) to the augmented MBCT group (i.e., MBCT plus treatment as usual [TAU]) or TAU (waitlist control) group. The cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), which is the ratio of the incremental costs divided by the incremental state-trait anxiety inventory- state (STAI-S), state-trait anxiety inventory- trait (STAI-T), and quality-adjusted life years (QALYs). The QALYs were estimated using The Japanese version of EuroQoL five-dimensional 3-level questionnaire. The unit cost data were derived from the government-regulated fees. This study was conducted from a public healthcare insurance perspective. No discount rates were considered. Results: A total of 38 participants with complete data were included in the analysis. The MBCT was JPY 13,885 more than the cost of TAU and was associated with a STAI-S, STAI-T, and QALY increase of 10.13, 12.00, 0.009 respectively. The ICER were JPY 1,371 (USD13) per STAI-S, JPY 1,157 (USD 11) per STAI-T, and JPY 1,566,357 (USD 14,940) per QALY respectively. MBCT had an 77.5% probability of being cost-effective at a willingness to pay threshold in Japan (JPY 5,000,000 per QALY). The results of the four one-way sensitivity analyses supported the robustness of the base-case analysis findings. Discussion: Augmented MBCT for anxiety disorders is cost-effective compared with TAU post-treatment from a public healthcare insurance perspective. Future studies should include long-term observations, and analysis from a societal perspective. Competing Interests: MS received grants from the Japanese Ministry of Education, Culture, Sports, Science, and Technology during the conduct of the study; honoraria from Shionogi & Co., Ltd. from Meiji Seika Pharma, Hisamitsu Pharmaceutical, Mochida Pharmaceutical, and Terumo Corporation and grant from Sony Corporate Services Corporation and Meiji Seika Pharma outside of the submitted work. AN received honoraria from Mochida Pharmaceutical Co., Ltd. and grants from Sony Corporate Services Corporation outside the submitted work. DF received research grants from Eisai Pharma and honoraria from Yoshitomiyakuhin Corporation, Mitsubishi Tanabe Pharma Corporation, and Eisai Pharma outside the submitted work. TK received grants from Gunma Hospital outside the submitted work. AN received royalties from Igaku-Shoin and Kongo-Shuppan and honoraria from Dainippon-Sumitomo Pharma, Pfizer, Yoshitomi Yakuhin, Otsuka Pharmaceutical, Meiji Seika, Tsumura & Co., and Mitsubishi Tanabe Pharma outside the submitted work. MM received grants and honoraria from Tsumura, Nishikawa-sangyo, and Teijin Pharma; personal fees from Chugai Pharmaceutical, Yoshitomiyakuhin Corporation, Shionogi &Co., Novartis Pharma K.K, Meiji Seika Pharma Co., Mochida Pharmaceutical Co., Eli Lilly Japan K.K, Janssen Pharmaceutical K.K, Fujifilm RI Pharma Co., Sumitomo Dainippon Pharma Co., Eisai Co., and Asahi Kasei Pharma Corporation; and personal fees from Astellas Pharma Inc., MSD K.K, Otsuka Pharmaceutical Co., Ono Pharmaceutical Co., and Pfizer Inc. outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2024 Sado, Koreki, Ninomiya, Kurata, Park, Fujisawa, Kosugi, Nagaoka, Nakagawa and Mimura.)
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