cost effectiveness

Mindfulness is a Cost-Effective Treatment to Prevent Depression Relapse

psyjdc Leave a comment

Mindfulness is a Cost-Effective Treatment to Prevent Depression Relapse

 

By John M. de Castro, Ph.D.

 

“MBCT significantly reduces the rates of depressive relapse or recurrence compared with usual care or placebo, corresponding to a relative risk reduction of 34%.” – Willem Kuyken

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating, impairing the ability of the patients to effectively conduct their lives. Depression can be difficult to treat and is usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression. Even after remission some symptoms of depression may still be present (residual symptoms).

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can relieve the suffering. Mindfulness-Based Cognitive Therapy (MBCT) was specifically developed to treat depression. MBCT involves mindfulness training, containing sitting, walking and body scan meditations, and cognitive therapy that is designed to alter how the patient relates to the thought processes that often underlie and exacerbate psychological symptoms. MBCT has been shown to be effective for the treatment of major depression. But there is little understanding of the cost-effectiveness of MBCT relative to drug treatment. So, it is important to take a serious look at the costs of implementing MBCT and its effectiveness in comparison to the costs and effectiveness of antidepressant pharmacotherapy.

 

In today’s Research News article “Cost-Utility Analysis of Mindfulness-Based Cognitive Therapy Versus Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a Canadian Context. Canadian journal of psychiatry” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492890/ )  Pahlevan and colleagues reviewed published research studies comparing the cost-effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) versus antidepressant pharmacotherapy for the prevention of relapse in patients with Major Depressive Disorder who had had at least 2 past episodes of major depression.

 

They report that the published research found that over a 2-year period Mindfulness-Based Cognitive Therapy (MBCT) costs $2,224.67 less than antidepressant pharmacotherapy and produces greater gains in quality of life. This greater cost effectiveness of MBCT disappeared when adherence rates were considered. Hence, the greater cost effectiveness of MBCT was due to its ability to motivate greater compliance with the treatment.

 

These results are important as when multiple effective treatments are available, the cost of treatment becomes important. The analysis suggests that Mindfulness-Based Cognitive Therapy (MBCT) not only costs less to deliver but also produces greater benefits. It is interesting that this advantage over antidepressant pharmacotherapy was due to improved compliance and not the superiority of the treatment. But a treatment is only as good as the patient’s adherence to its requirements and MBCT  produces greater adherence.

 

So, mindfulness is a cost-effective treatment to prevent depression relapse.

 

“The rationale behind the MBCT program is based on an empirically supported, theoretical framework suggesting that patients with recurrent depression become more vulnerable to developing depression as cognitive reactivity increases.” – Marloes J Huijbers

 

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Pahlevan, T., Ung, C., & Segal, Z. (2020). Cost-Utility Analysis of Mindfulness-Based Cognitive Therapy Versus Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a Canadian Context: Analyse coût-utilité de la thérapie cognitive basée sur la pleine conscience contre la pharmacothérapie antidépressive pour prévenir la rechute de la dépression en contexte canadien. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 65(8), 568–576. https://doi.org/10.1177/0706743720904613

 

Abstract

Objective:

Patients suffering from major depressive disorder (MDD) experience impaired functioning and reduced quality of life, including an elevated risk of episode return. MDD is associated with high societal burden due to increased healthcare utilization, productivity losses, and suicide-related costs, making the long-term management of this illness a priority. The purpose of this study is to evaluate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT), a first-line preventative psychological treatment, compared to maintenance antidepressant medication (ADM), the current standard of care.

Method:

A cost–utility analysis was conducted over a 24-month time horizon to model differences between MBCT and ADM in cost and quality-adjusted life years (QALY). The analysis was conducted using a decision tree analytic model. Intervention efficacy, utility, and costing data estimates were derived from published sources and expert consultation.

Results:

MBCT was found to be cost-effective compared to maintenance ADM over a 24-month time horizon. Antidepressant pharmacotherapy resulted in 1.10 QALY and $17,255.37 per patient on average, whereas MBCT resulted in 1.18 QALY and $15,030.70 per patient on average. This resulted in a cost difference of $2,224.67 and a QALY difference of 0.08, in favor of MBCT. Multiple sensitivity analyses supported these findings.

Conclusions:

From both a societal and health system perspective, utilizing MBCT as a first-line relapse prevention treatment is potentially cost-effective in a Canadian setting. Future economic evaluations should consider combined treatment (e.g., ADM and psychotherapy) as a comparator and longer time horizons as the literature advances.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492890/

 

Cost Effectively Improve Cancer Patients’ Quality of Life with Mindfulness

psyjdc Leave a comment

Cost Effectively Improve Cancer Patients’ Quality of Life with Mindfulness

 

By John M. de Castro, Ph.D.

 

“People don’t ask to be diagnosed with cancer, but they’re given an opportunity to, in a real sense, experience the vividness and the exquisiteness of the moment.” – Linda Carlson

 

Receiving a diagnosis of cancer has a huge impact on most people. Feelings of depression, anxiety, and fear are very common and are normal responses to this life-changing and potentially life-ending experience. These feeling can result from changes in body image, changes to family and work roles, feelings of grief at these losses, and physical symptoms such as pain, nausea, or fatigue. People might also fear death, suffering, pain, or all the unknown things that lie ahead. So, coping with the emotions and stress of a cancer diagnosis is a challenge and there are no simple treatments for these psychological sequelae of cancer diagnosis.

 

Mindfulness training has been shown to help with cancer recovery and help to alleviate many of the residual physical and psychological symptoms, including fatigue, stress,  sleep disturbance, fear, and anxiety and depression. The effectiveness of mindfulness training for the psychological symptoms of cancer has been established. But whether it is cost-effective relative to other treatments has not been investigated.

 

The vast majority of the mindfulness training techniques, however, require a trained therapist. This results in costs that many parents can’t afford. In addition, the participants must be available to attend multiple sessions at particular scheduled times that may or may not be compatible with parents’ busy schedules and at locations that may not be convenient. As an alternative, mindfulness trainings over the internet have been developed. These have tremendous advantages in making training schedules much more flexible, and eliminating the need to go repeatedly to specific locations. But the question arises as to the cost effectiveness of these online trainings.

 

In today’s Research News article “Cost-utility of individual internet-based and face-to-face Mindfulness-Based Cognitive Therapy compared with treatment as usual in reducing psychological distress in cancer patients.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027540/), Compen and colleagues recruited past or present cancer patients with high anxiety levels and randomly assigned them to be on a wait-list receiving treatment as usual or Mindfulness-Based Cognitive Therapy (MBCT) either delivered face-to-face or over the internet. Face-to-face MBCT occurred in 8 weekly 2.5-hour sessions with 45 minutes of daily practice at home. The internet version had similar content but was delivered asynchronously personally with email exchanges with therapists.

Costs were calculated by calculating the costs of normal treatment as usual as well as indirect costs from absenteeism, productivity losses etc. and the costs of delivering the services. Quality of life was assessed for each patient.

 

They found that the costs of delivery of Mindfulness-Based Cognitive Therapy (MBCT) was equivalent between face-to-face and internet delivery. The productivity losses and total costs were significantly less with both MBCT deliveries compared to treatment as usual. Quality of life was significantly higher with both MBCT deliveries and was maintained at a 9-month follow-up.

 

The results suggest that delivering Mindfulness-Based Cognitive Therapy (MBCT) either face-to-face or over the internet reduces total costs of treatment and work-related losses and improved the quality of life of cancer patients. This suggests that MBCT is a cost effective way of delivering treatment to cancer patients, making their lives better.

 

So, cost effectively improve cancer patients’ quality of life with mindfulness.

 

“Cancer is a traumatic event that changes a person’s life. Utilizing mindfulness tools can provide peace and hope. Practicing mindfulness on a daily basis can assist with long term effects of happiness and positivity. – Erin Murphy-Wilczek

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Compen, F., Adang, E., Bisseling, E., van der Lee, M., & Speckens, A. (2020). Cost-utility of individual internet-based and face-to-face Mindfulness-Based Cognitive Therapy compared with treatment as usual in reducing psychological distress in cancer patients. Psycho-oncology, 29(2), 294–303. https://doi.org/10.1002/pon.5246

 

Abstract

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 with treatment as usual (TAU) in reducing psychological distress. In this study, the incremental cost‐utility of both interventions compared with TAU was assessed.

Methods

This cost‐utility 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 with 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‐month 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.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027540/

 

Mindfulness is a Cost-Effective Treatment for Fibromyalgia

psyjdc Leave a comment

Mindfulness is a Cost-Effective Treatment for Fibromyalgia

 

By John M. de Castro, Ph.D.

 

“Mindfulness as a practice of conscious meditation affects brain activity, achieving, on the one hand, deactivating the areas of negative pain assessment and, on the other, activating those related to the healing and resilience processes. In this way, it helps calm the sympathetic nervous system, which usually leads to reduced stress levels, on the one hand, and also the sensation of perceived pain.” – Andres Martin

 

Fibromyalgia is a mysterious disorder whose causes are unknown. It is very common affecting over 5 million people in the U.S., about 2% of the population with about 7 times more women affected than men. It is characterized by widespread pain, abnormal pain processing, sleep disturbance, and fatigue that lead to psychological distress. Fibromyalgia may also have morning stiffness, tingling or numbness in hands and feet, headaches, including migraines, irritable bowel syndrome, sleep disturbances, thinking and memory problems, and painful menstrual periods. The symptoms are so severe and debilitating that about half the patients are unable to perform routine daily functions and about a third have to stop work. Although it is not itself fatal, suicide rates are higher in fibromyalgia sufferers. Clearly, fibromyalgia greatly reduces the quality of life of its’ sufferers.

 

There are no completely effective treatments for fibromyalgia. Symptoms are generally treated with pain relievers, antidepressant drugs and exercise. But these only reduce the severity of the symptoms and do not treat the disease directly. Mindfulness practices have also been shown to be effective in reducing pain from fibromyalgia. Some of the effects of mindfulness practices are to alter thought processes, changing what is thought about. In terms of pain, mindfulness training, by focusing attention on the present moment has been shown to reduce worry and catastrophizing. Pain is increased by worry about the pain and the expectation of greater pain in the future. So, mindfulness may reduce worry and catastrophizing and thereby reduce fibromyalgia pain and improve the quality of life.

 

The effectiveness of mindfulness training for the treatment of fibromyalgia pain has been established. But whether it is cost-effective relative to other treatments has not been investigated. In today’s Research News article “Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study).” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/), Pérez-Aranda and colleagues examine the cost-effectiveness of Mindfulness-Based Stress Reduction (MBSR) training for the treatment of fibromyalgia.

 

They recruited adult fibromyalgia patients and continued treatment as usual. The patients were then randomly assigned to receive once a week for 2 hours for 8 weeks either Mindfulness-Based Stress Reduction (MBSR) or relaxation and Fibromyalgia education, or were assigned to receive no additional treatment as. The MBSR program consisted of meditation, yoga, body scan, and discussion. The patients were also encouraged to practice at home. They were measured before and after the intervention and 12 months later for health-related quality of life, current health status, medications, and health services.

 

They found that over the year following treatment there were significant increases in the patient’s quality of life and their current health status for the Mindfulness-Based Stress Reduction (MBSR) group but not for the fibromyalgia education or treatment as usual groups. In addition, there was a significant reduction in total healthcare costs including the costs of the interventions for the MBSR group only. The largest reduction in costs for the MBSR group was in primary healthcare costs. So, MBSR training reduced treatment costs and increased the health-related quality of life of the fibromyalgia patients. Hence,  MBSR training is a safe, effective, and very cost effective treatment for fibromyalgia.

 

So, mindfulness is a cost-effective treatment for fibromyalgia.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Pérez-Aranda, A., D’Amico, F., Feliu-Soler, A., McCracken, L. M., Peñarrubia-María, M. T., Andrés-Rodríguez, L., … Luciano, J. V. (2019). Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). Journal of clinical medicine, 8(7), 1068. doi:10.3390/jcm8071068

 

Abstract

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678679/

 

Tai Chi Practice is a Cost-Effective Treatment to Reduce Falls in Older Adults

psyjdc Leave a comment

Tai Chi Practice is a Cost-Effective Treatment to Reduce Falls in Older Adults

 

By John M. de Castro, Ph.D.

 

“Across multiple studies, Tai chi appears to reduce risk of falling by 20 to 45 percent and is considered one of the best exercises available for ambulatory older adults with balance concerns.” – Peter Wayne

 

The process of aging affects every aspect of the physical and cognitive domains. Every system in the body deteriorates including motor function with a decline in strength, flexibility, and balance. Impaired balance is a particular problem as it can lead to falls. In the U.S. one third of people over 65 fall each year and 2.5 million are treated in emergency rooms for injuries produced by falls. About 1% of falls result in deaths making it the leading cause of death due to injury among the elderly.

 

Falls, with or without injury, also carry a heavy quality of life impact. A growing number of older adults, fear falling and, as a result, limit their activities and social engagements. This can result in further physical decline, depression, social isolation, and feelings of helplessness. It is obviously important to discover methods to improve balance and decrease the number of falls in the elderly.

 

Tai Chi training is designed to enhance and regulate the functional activities of the body through regulated breathing, mindful concentration, and gentle movements. It includes balance training and has been shown to improve balance and coordination. Indeed, Tai Chi training has been shown to reduce the frequency of falls in the elderly. It is not known, however, if Tai Chi training is more or less cost-effective than other exercises for reducing falls in the elderly.

 

In today’s Research News article “Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696718/), Li and colleagues recruited community-based elderly individuals (over 70 years of age) who had experienced at least one fall in the last year and randomly assigned them to one of three conditions; Tai Chi practice, multimodal (mixed) exercises, or stretching. The exercises occurred in twice weekly, 60-minute sessions, for 24 weeks. They were measured before and after training for falls, health related quality of life, health index, quality-adjusted life-years (QALYs), and health-related service utilization expenses.

 

They found that Tai Chi practice resulted in significantly greater reduction in falls and increase in quality-adjusted life-years (QALYs) than either the multimodal or stretching exercises. The costs of implementing the 3 programs were equivalent. The total health-related utilization cost was $1,958 per participant for Tai Chi, compared with $2,583 for multimodal and $2,131 for stretching. Tai Chi produced greater reductions in falls at a lower cost and resulted in lower health care costs results in in incremental costs of $850 per additional fall prevented and $27,614 per additional QALY gained.

 

These results suggest that Tai Chi practice is a safe, effective, and cost-effective means of reducing falls in the elderly. Falls when they occur in the elderly can be quite devastating and can produce major injuries that can even lead to death. So, their prevention is very important not just for reducing health care costs but for the longevity and quality of life of the individual.

 

So, Tai Chi practice is a cost-effective treatment to reduce falls in older adults.

 

“Falling in adults age 65 and older is significantly associated with loss of independence, premature mortality and big health care costs.” – Peter Harmer

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Li, F., Harmer, P., Eckstrom, E., Fitzgerald, K., Akers, L., Chou, L. S., … Winters-Stone, K. (2019). Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling. The journals of gerontology. Series A, Biological sciences and medical sciences, 74(9), 1504–1510. doi:10.1093/gerona/glz008

 

Abstract

Background

Data on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling.

Methods

We conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon.

Results

The total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered.

Conclusions

Among community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6696718/

 

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

psyjdc Leave a comment

Mindfulness Therapies May Be Cost-Effective for the Treatment of Mental Illness

 

By John M. de Castro, Ph.D.

 

“[Mindfulness] is a cost-saving alternative to treatment as usual over the trial duration from both a healthcare and a societal perspective for patients with a diagnosis of depression, anxiety or stress and adjustment disorders.” – Sanjib Saha

 

There has developed a large volume of research findings supporting the effectiveness of mindfulness training for the treatment of mental illnesses. Effectiveness has been documented for a wide variety of psychological disorders including anxiety, depression, stress responses, obsessive-compulsive disorder, eating disorders, addictions, and major mental illnesses. But there is little understanding of the cost-effectiveness of these mindfulness trainings. So, it is important take a serious look at the costs of implementing these therapies in comparison to the healthcare savings produced and/or the costs of other treatments of similar effectiveness.

 

In today’s Research News article “Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/), Duarte and colleagues review and summarize the published studies of the cost-effectiveness of acceptance and mindfulness-based interventions. The following acceptance and mindfulness-based interventions were identified:  Mindfulness Based Cognitive Therapy (MBCT), Mindfulness-Based Stress Reduction (MBSR) , Dialectical Behavior Therapy (DBT),  Acceptance and Commitment Therapy (ACT), mindfulness‐based relapse prevention (MBRP), and other mindfulness meditation and mindfulness training. They identified 10 published studies.

 

They reported that the published studies found mixed results depending on the type of economic analysis and the comparator condition. In general, they report that acceptance and mindfulness-based interventions are mildly cost-effective for the treatment of depression, emotional unstable personality disorder, and general mental health conditions. It is clear, however, that this issue needs to be further studied.

 

In an age of high healthcare costs, it is important to perform economic analyses of treatments. Before widespread implementation of a treatment it is important to know that the costs of implementing the treatments are less than the healthcare savings produced. Various acceptance and mindfulness-based interventions can be expensive to implement and the savings produced hard to evaluate. So, the analysis has produced ambiguous results. One way to improve the cost-effectiveness of acceptance and mindfulness-based interventions is to implement the therapies online or with smartphone technologies. This markedly reduces the costs while maintaining effectiveness.

 

So, mindfulness therapies may be cost-effective for the treatment of mental illness.

 

“MBSR reduced costs to society by $724 per year in comparison to usual care, and reduced healthcare costs to payers by $982; it also increased participants’ quality-adjusted life years.” – Patricia Herman

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R. (2019). Are acceptance and mindfulness-based interventions ‘value for money’? Evidence from a systematic literature review. The British journal of clinical psychology, 58(2), 187–210. doi:10.1111/bjc.12208

 

Abstract

Objectives

Acceptance and mindfulness‐based interventions (A/MBIs) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/MBIs for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.

Methods

Eight electronic bibliographic databases (MEDLINE, MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE, Web of Science, NHS Economic Evaluation Database (EED), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment (HTA) database, and EconLit) were searched for relevant economic evaluations published from each database’s inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines.

Results

Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/MBIs were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made.

Conclusion

This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.

Practitioner points

The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized.

Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.

Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings.

The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588093/

 

Improve Health and Lower Costs with Workplace Mindfulness

psyjdc Leave a comment

 

By John M. de Castro, Ph.D.

 

“Mindfulness is, above all, about being aware and awake rather than operating unconsciously. When you’re consciously present at work, you’re aware of two aspects of your moment-to-moment experience—what’s going on around you and what’s going on within you.” –  Shamash Alidina

 

A healthcare system is only as good as the propensity of people to utilize it. For a number of reasons including procrastination, denial, fear, etc. people often do not go to the doctor even when needed. This can have negative health consequences. On the other hand, using the health care system in a timely manner promotes health by preventing disease or increasing early diagnosis which can reduce the duration and severity of disease. So, counterintuitively, using the healthcare system can actually reduce costs. Hence finding methods to promote the timely and appropriate use of the healthcare system is in everyone’s interest.

 

In the U.S., the majority of health insurance is provided by employers who are responsible for the costs. So, it is in the best interest of employers to promote the health of their employees to reduce costs and improve their bottom line. This is a win-win situation where health promotion in the workplace is good both for the employer and the employee. There have been a number of programs implemented in the workplace that have been tried to improve employee health. A common program is one that promotes a healthy diet and exercise. Less common, but growing in popularity are programs that employ mindfulness training. But, to date there has not been a direct comparison of the two.

 

In today’s Research News article “A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1412011575489431/?type=3&theater

or see summary: Klatt and colleagues recruited faculty and staff who participated in the university’s health care plan which also tracked costs. They were randomly assigned to receive either a diet and exercise education program or a mindfulness training program, or to a no-treatment matched control group. They measured health care costs for the nine months prior to the trainings and for five years after. The mindfulness training was a group based training in mindfulness meditation while the diet and exercise education program worked to improve awareness of health behaviors.

 

They found that both training groups, in comparison to controls, had increased use of the healthcare system as evidenced by an increase in prescription medications but a decreased use of primary care, fewer hospital admissions, and overall lower healthcare costs. The overall savings averaged $4,000 per employee per year. Hence, both mindfulness and diet and exercise training programs resulted in substantially lower healthcare costs that were maintained over a 5-year period. To have such a long-term follow-up is extremely rare but very valuable as it demonstrates that the training programs have enduring consequences.

 

The authors “hypothesize that the results of this study reflect that both of the original interventions raised health awareness, so that participants were more proactive and involved in their health.” It is likely that they did so in different ways. Diet and exercise education did so directly by stressing engaging in health behaviors while mindfulness training did so by raising the individual’s awareness of their body and physical state. If this is true it suggests that combining the two interventions may have an even greater impact on health and healthcare costs.

 

So, improve health and lower costs with workplace mindfulness.

 

“Once you learn mindfulness skills, you can practice them at almost any moment of the day—sitting at your computer, stuck in traffic, even eating. In fact, there has been a . . . growing interest in using the practice of mindfulness in the workplace to provide a buffer against stress.” – Jason Marsh

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Klatt MD, Sieck C, Gascon G, Malarkey W, Huerta T. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention. Complement Ther Med. 2016 Aug;27:139-44. doi: 10.1016/j.ctim.2016.05.008.

 

Abstract

Objective: To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group.

Design and setting: We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n = 84) and the diet/exercise intervention (n = 86) to a retrospectively matched control group (n = 258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study.

Main outcome measures: Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention.

Results: Significantly fewer primary care visits (p < .001) for both intervention groups as compared to controls, with a non-significant trend towards lower overall HC utilization (4,300.00 actual dollar differences) and hospital admissions for the intervention groups after five years. Pharmacy costs and number of prescriptions were significantly higher for the two intervention groups compared to controls over the five years (p < 0.05), yet still resulted in less HC utilization costs, potentially indicating greater self-management of care.

Conclusion: This study provides valuable information as to the cost savings and value of providing workplace lifestyle interventions that focus on awareness of one’s body and health. Health economic studies validate the scale of personal and organization health cost savings that such programs can generate.

Cost Effectively Treat Recurrent Depression with Mindfulness

psyjdc 1 Comment

 

By John M. de Castro, Ph.D.

 

“Depression is not only the most common mental illness, it’s also one of the most tenacious. Up to 80 percent of people who experience a major depressive episode may relapse. Drugs may lose their effectiveness over time, if they work at all. But a growing body of research is pointing to an intervention that appears to help prevent relapse by altering thought patterns without side effects: mindfulness-based cognitive therapy, or MBCT”. – Stacy Lu

 

Clinically diagnosed depression is the most common mental illness, affecting over 6% of the population. Major depression can be quite debilitating. It is also generally episodic, coming and going. Some people only have a single episode but most have multiple reoccurrences of depression.  Depression can be difficult to treat and usually treated with anti-depressive medication. But, of patients treated initially with drugs only about a third attained remission of the depression. After repeated and varied treatments including drugs, therapy, exercise etc. only about two thirds of patients attained remission. But, drugs often have troubling side effects and can lose effectiveness over time. In addition, many patients who achieve remission have relapses and recurrences of the depression.

 

Being depressed and not responding to treatment or relapsing is a terribly difficult situation. The patients are suffering and nothing appears to work to relieve their intense depression. Suicide becomes a real possibility. So, it is imperative that other treatments be identified that can be applied when the typical treatments fail. Mindfulness training is another alternative treatment for depression. It has been shown to be an effective treatment for depression and is also effective for the prevention of its recurrence. Mindfulness Based Cognitive Therapy (MBCT) was specifically developed to treat depression and can be effective even in the cases where drugs fail. Hence, MBCT is a promising alternative treatment. As such, it is important to further investigate its effectiveness. But, costs are also important, so determining the cost-effective of MBCT is also very important.

 

In today’s Research News article “Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care?” See:

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1408935652463690/?type=3&theater

or see summary below, Shawyer and colleagues recruited adults who were in remission from verified Major Depressive Disorder and engaged them in a continuous self-monitoring of depression. They were then randomly assigned them to either receive no-treatment or 8 weeks of 2 hour, once a week, Mindfulness-Based Cognitive Therapy (MBCT) with once a month optional booster sessions for 3 months. They measured days depressed, patient quality of life, and the economic costs of disability and treatment, before and after treatment and 14 and 24 months later.

 

They found that over the two years of the study that the patients receiving MBCT had significantly fewer days (44%) with depression than control patients regardless of whether treatment was performed in primary or secondary care facilities. This resulted in major cost savings, with the yearly costs for mental health treatment for the MBCT treated patients 32% lower and overall health care costs 24% lower than control patients. Hence, Mindfulness-Based Cognitive Therapy (MBCT) was found to be not only an effective treatment for reoccurrence of major depression, but also a cost-effective treatment.

 

MBCT uses mindfulness training and cognitive training to allow the patients to reprogram their thought patterns and how they interpret experiences, recognizing that their thoughts are only, just that, thoughts and not reflective of their selves. They learn to experience their emotions but adaptively react to them, seeing them as simply experiences that come and go. The results of today’s Research News study demonstrates, as have a number of other studies, that this approach is effective for the treatment of recurrent depression. But, in today’s cost conscious medical environment, the study, importantly, demonstrated that MBCT also reduces health care costs. Hence, MBCT improves major depression cost-effectively.

 

So, cost effectively treat recurrent depression with mindfulness.

 

CMCS – Center for Mindfulness and Contemplative Studies

 

“Through mindfulness, individuals start to see their thoughts as less powerful. These distorted thoughts – such as “I always make mistakes” or “I’m a horrible person” – start to hold less weight. We ‘experience’ thoughts and other sensations, but we aren’t carried away by them. We just watch them come and go.” – William Marchand

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts

 

Study Summary

Frances Shawyer, Joanne C Enticott, Mehmet Özmen, Brett Inder,and Graham N Meadows Mindfulness-based cognitive therapy for recurrent major depression: A ‘best buy’ for health care? Aust N Z J Psychiatry, October 2016; vol. 50, 10: pp. 1001-1013., first published on April 19, 2016

 

Abstract

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.

Method: 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.

Conclusion: 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.

http://anp.sagepub.com.ezproxy.shsu.edu/content/50/10/1001.full

Reduce Healthcare Costs with Mindfulness

psyjdc Leave a comment

“If we want to lower the costs of healthcare, we need to reduce the demand for healthcare services – not increase supply.” – Charles A. Francis

 

“Mindfulness is now more relevant than ever as an effective and dependable counterbalance to strengthen our health and well-being, and perhaps our very sanity.”  ― Jon Kabat-Zinn

 

In the United States the costs of healthcare are out of control. We pay more per capita by far than any other country in the world and yet our healthcare outcomes are mediocre at best. Healthcare spending per person in the U.S. is over $10,000 per year, 17% of the Gross Domestic Product, over $3 Trillion. Increasingly, Americans are having problems paying for care — 26 percent report they or a family member had problems paying medical bills in the past year. Fifty-eight percent of Americans reported foregoing or delaying medical care in the past year. Many patients stop taking medications or never fill prescriptions due to unaffordability.

 

Costs are putting a strain on the finances of individuals and the entire country. Obviously there is a need to somehow control costs while improving the quality of healthcare services. One strategy is to attempt to reduce the costs of providing care. This, however, has proved to be extremely challenging. Another tactic is to work toward reducing the need for services. This can include methods to prevent illness and shorten or dampen illnesses when they do occur. Mindfulness practices have been shown to do just that, preventing illness, decreasing symptoms, and improving recovery as a stand-alone treatment or as an adjunct to conventional treatments (see http://contemplative-studies.org/wp/index.php/category/research-news/health/ and http://contemplative-studies.org/wp/index.php/category/research-news/well-being/).

 

In today’s Research News article “The low risk and high return of integrative health services”

https://www.facebook.com/ContemplativeStudiesCenter/photos/a.628903887133541.1073741828.627681673922429/1170859096271348/?type=3&theater

Russo and colleagues review the studies of the effects of alternative treatments including mindfulness practices on costs for healthcare services. They found that the use of mindfulness techniques reduced overall hospital costs. This occurred due to reduced length of stay in the hospital prior to and immediately following surgery, decreased use of prescription drugs which in turn further reduced length of stay, post-operative co-morbidities, and drug dependence, while increasing patient self-care. The use of mindfulness practices also decreased anxiety, pain, and narcotic use and improve patient satisfaction.

 

The exact amount of money saved depends upon many complex factors such as the interventions used, the practices used, the structure of the program, and facilities used. But, some examples can highlight the magnitude of the savings. The application of yoga training to cancer treatment resulted in cost savings of $156 per day, nearly $300,000 annually. Application of mindfulness techniques to diabetes care resulted in estimated savings of $31,000 per person per year. These savings were calculated after all of the costs associated with running the programs were subtracted. Obviously, considerable savings can be obtained by hospitals with the use of mindfulness techniques.

 

To my knowledge, there have not been any estimates of the savings produced by mindfulness practices with outpatient and non-hospital healthcare cost reductions and by disease prevention. So, the actual impact of the use of mindfulness techniques on healthcare costs is unknown but logic suggests that the savings are huge.

 

These are important findings and underscore the economic consequences of the application of mindfulness techniques to healthcare. Unfortunately, in the American healthcare system there is no incentives to reduce the number of treatments employed as the providers are paid according to the number of services provided rather than value and effectiveness of the services. The move toward outcomes-based payments may help in this regard. But, clearly there is a need to change the incentives in the system to promote wellness and reduced costs. Mindfulness practices have been proven to do just that.

 

Regardless, it is clear that we can reduce healthcare costs with mindfulness.

 

“People don’t actually want to think about their own health and don’t take action until they are sick. Yet employers are very motivated to get their employees healthy, since they bear most of the burden of their health care costs.” – Clayton Christensen

 

CMCS – Center for Mindfulness and Contemplative Studies