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

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.

The Development and Internal Evaluation of a Predictive Model to Identify for Whom Mindfulness-Based Cognitive Therapy Offers Superior Relapse Prevention for Recurrent Depression Versus Maintenance Antidepressant Medication

“…Clinically, our data indicate that treatment selection for depressive relapse prevention in individuals with recurrent depression who have a moderate to good ADM prognoses could be guided by factors such as patient preference, cost, and resource availability. While resource availability may be a limiting factor, cost-benefit analysis have shown non-inferiority of MBCT ( Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Morant, et al, 2015 ) and some even favored MBCT over ADM ( Pahlevan et al, 2020 ). For individuals with a poor prognosis on ADM, however, our data indicate that MBCT alongside tapering or cessation of medication to prevent relapse potentially confers a better clinical outcome and should be offered as an alternative to ADM.…”

The Development and Internal Evaluation of a Predictive Model to Identify for Whom Mindfulness-Based Cognitive Therapy Offers Superior Relapse Prevention for Recurrent Depression Versus Maintenance Antidepressant Medication

“…Clinically, our data indicate that treatment selection for depressive relapse prevention in individuals with recurrent depression who have a moderate to good ADM prognoses could be guided by factors such as patient preference, cost, and resource availability. Although resource availability may be a limiting factor, costbenefit analyses have shown noninferiority of MBCT (Kuyken et al, 2015b), and some have even favored MBCT over ADM (Pahlevan et al, 2020). For individuals with poor prognoses on ADM, however, our data indicate that MBCT alongside tapering or cessation of medication to prevent relapse potentially confers a better clinical outcome and should be offered as an alternative to ADM.…”

Trial‐based economic evaluation of mindfulness‐based cognitive therapy compared to treatment as usual for bipolar disorder

“…This study will establish the cost‐effectiveness of a guided self‐help mindfulness based intervention for people with BD. A few studies have evaluated the cost‐effectiveness of MBCT in people with depression (Kuyken et al., 2015 ; Pahlevan et al., 2020 ; Saha et al., 2020 ). Mindfulness‐based cognitive therapy seems to be potentially cost‐effective compared to maintenance antidepressant medication (standard of care) in people suffering from major depressive disorder (Pahlevan et al., 2020 ), from both healthcare and societal perspective.…”