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Table 16 Cost-effectiveness Outcomes: MUS

From: A systematic review of economic analyses of psychological interventions and therapies in health-related settings

Authors, Year

Type of Analysis/

Type of Costs

Costs

Type of effectiveness outcome

Effectiveness

ICER (definition);

ICER (results)

Sensitivity Analysis (definitions)

Sensitivity analysis (results)

Authors conclude (Reviewer comments where these differ from authors)

Chernyak et al. 2014 [43*]

CUA

Costs (direct treatment):

Intervention: €893; Control: €141

SF-36 PCS (mean improvement):

Intervention: 5.3;

Control: 2.2

ICER (cost per QALY gained):

€41,840 per QALY gained

Parameters varied

Handling of missing data (exclude, LOCF and imputation)

Highly uncertain

SF-6D (improvement)

Intervention: 0.09; Control: 0.04

Bootstrapping Y/N (iterations):

Y (5000 replications);

WTP Threshold(s)

€35,000 per QALY gained

Probability cost-effective at WTP

“exceeded 50%”

Schroder et al. 2017 [91*]

CUA

Annual healthcare costs

STreSS at 1 year pre treatment €3544, 4 months €2369, 1 year €2250, 2 years €2560, 3 years €523; EUC at 1 year pre-treatment,€4106 at 4 months €976, at 1 year €4200, at 2 years €3937 and 3 years €1132

% achieving clinically significant improvement during 16 months, defined as 0.5 SD change (4 point increase) on SF-36 aggregate score and 0.35 points reduction on the SCL-90 R somatisation subscale.

STreSS: 45% (30–60);

EUC: 17% (7–27)

ICER (cost per additional patient with clinically significant improvement, cost per QALY gained using healthcare costs only, cost per QALY gained using total costs):

€3035 to €4398 per patient improved;

Intervention was dominant per QALY gained when healthcare costs used; €24,640 euros per QALY gained at 16 months when total costs used.

Bootstrapping Y/N (iterations):

Y (1000 replications)

Cost effective per QALY gained (for societal perspective the cost-effectiveness may be underestimated)

Annual costs (direct plus indirect including tax income)

STreSS at 1 year pre-treatment €12,489, 4 months €5487, 1 year €11,118, 2 years €9353, 3 years €6334; EUC at 1 year pre-treatment €15,904, at 4 months €3888, at 1 year €14,799, at 2 years €16,109 at 3 years €15,701

QALYs accrued at 16 months (SF-36 converted to SF-6D)

STreSS: 0.80;

EUC: 0.75

WTP Threshold(s)

€5000 per additional patient achieving clinically significant improvement,

€25,000 to 35,000 per QALY

Probability cost-effective at WTP

93–95% (health-care perspective);

50-55% (societal perspective but healthcare threshold used)

van Ravesteijn et al. 2013 [101*]

CUA

Mean societal costs over 1 year (bootstrapped):

Intervention: €6269;

Control: €5617;

Total costs were not significantly different, but mental health care costs were higher and hospital care costs lower in the intervention group.

Change in utility score over 1 year

Intervention: 0.06;

Control: 0.04

ICER (cost per QALY gained):

Societal perspective:

€56,637 per QALY gained Healthcare perspective: €66,450

Parameters varied

Scenario analysis that varied perspective, and using per protocol trial data (ICERs ranged from €41,167 to €53,198)

Uncertain whether MBCT is cost-effective.

Mean costs of intervention

Intervention: €450; Control: N/A

QALYs gained

Intervention: 0.674; Control: 0.663; Bootstrapped difference in QALYs 0.012 (95% CI −0.019 to 0.041) was not statistically significant.

Bootstrapping Y/N (iterations):

Y, (1000 replications).

WTP Threshold(s)

€0 to €80,000

Probability cost-effective at WTP

Societal perspective: At WTP threshold of €0, the probability of MBCT being cost effective is 28%. At WTP of €40,000 this is 48%. At €80,000 it is 57%. Healthcare perspective results “did not significantly differ [from societal perspective]”, At a WTP threshold of €80,000 the probability that MBCT is cost-effective is 55%.

Visser et al. 2015 [103*]

CUA (Markov model)

Societal costs over 4 years

Intervention: €32,929; Control: €33,757

QALYs gained

Intervention: 2.35 QALYs; Control: 2.29 QALYs

ICER (cost per QALY gained):

Intervention dominant from societal perspective; €8165 for healthcare perspective

Parameters varied

Probabilistic sensitivity analysis (10,000 iterations). Scenario analysis including only healthcare perspective, time horizon.

Cost effective

Healthcare costs over 4 years

Intervention: €21,757; Control: €21,278

WTP Threshold(s)

€30,000 per gained QALY

Probability cost-effective at WTP

80% at WTP threshold.