title: Mindfulness-based cognitive therapy for patients with medically unexplained symptoms: a cost-effectiveness study.
abstract: 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 €6269, and €5617 for EUC (95% uncertainty interval for difference: -€1576; €2955). 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 €56,637 per QALY gained. At a willingness to pay of €80,000 per QALY, the probability that MBCT is cost-effective is 57%.
  
  
  CONCLUSIONS
  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.
authors: Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. h.vanravesteijn@psy.umcn.nl
authors: Hiske
authors: H
authors: van Ravesteijn
authors: Janneke
authors: J
authors: Grutters
authors: Tim
authors: T
authors: olde Hartman
authors: Peter
authors: P
authors: Lucassen
authors: Hans
authors: H
authors: Bor
authors: Chris
authors: C
authors: van Weel
authors: Gert Jan
authors: GJ
authors: van der Wilt
authors: Anne
authors: A
authors: Speckens
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005081:Exercise Therapy / Q000191:economics / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019122:Meditation / Q000379:methods*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D019057:Quality-Adjusted Life Years; D013001:Somatoform Disorders / Q000191:economics / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome