Mindfulness-based cognitive therapy for recurrent major depression: A 'best buy' for health care?
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.


METHODS
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.


CONCLUSIONS
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.
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Frances
F
Shawyer
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Joanne C
JC
Enticott
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia Department of Econometrics and Business Statistics, Faculty of Business and Economics, Monash University, Melbourne, VIC, Australia.
Mehmet
M
Özmen
Department of Econometrics and Business Statistics, Faculty of Business and Economics, Monash University, Melbourne, VIC, Australia.
Brett
B
Inder
Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia Mental Health Program, Monash Health, Melbourne, VIC, Australia Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia graham.meadows@monash.edu.
Graham N
GN
Meadows
D000328:Adult; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D003865:Major Depressive Disorder / Q000191:economics / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D064866:Mindfulness / Q000191:economics / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000191:economics; D012008:Recurrence; D015928:Cognitive Behavioral Therapy
Randomised controlled trial; cost-effectiveness; health economics; major depressive disorder; mindfulness-based cognitive therapy