Posted 06.22.2017 | by AMRA

One in five breast cancer survivors report significant pain that persists years after the conclusion of medical treatment. Persistent post-treatment pain reduces cancer survivors’ quality of life and contributes to greater health care costs due to increased medical visits and medication usage. While mindfulness-based interventions have been shown to reduce pain in cancer survivors, little is known about the overall cost effectiveness of these interventions.

Johannsen et al. [Psycho-Oncology] analyzed data from a previously published randomized, controlled trial of Mindfulness-Based Cognitive Therapy (MBCT) to reduce pain in breast cancer survivors, in order to explore its cost effectiveness.

The researchers randomly assigned 129 Danish female breast cancer patients who had completed treatment and reported persistent pain to either an 8-week trial of MBCT or a wait-list control group. Health care utilization and cost analyses were performed only for a subset of 84 patients for whom there was no missing data. The MBCT intervention followed the standard weekly two-hour group protocol. Subjective pain ratings were collected from the patients at baseline, immediately at the end of the intervention, and at 3 and 6-month follow-up.

The treatment was deemed a success if a patient decreased her pain by at least two points on a 10-point rating scale, which was deemed to be the minimal clinically meaningful difference. A Danish national health registry was the source of information about healthcare utilization and prescription medication usage and costs during the 6-month follow-up period.

As previously reported, 53% of the MBCT patients reduced their pain by at least two points, whereas only 29% of the wait list controls did. MBCT patients made significantly fewer visits to general practitioners, medical specialists, physical therapists and psychologists. They also had fewer hospital visits and shorter hospital stays during the six-month follow-up period than did controls. MBCT patients filled significantly more prescriptions for tricyclic antidepressants (an average of 1.84 vs. 1.03 prescriptions per patient) than controls.

Total average health care utilization costs for the 6-month follow-up period (all medical visits, hospital stays, and medication) came to $1,911 per MBCT patient and $2,728 per control–an average cost saving of $817 for MBCT patients.

The study demonstrates that MBCT resulted in reduced pain, medical utilization, and medical costs compared to a wait-list control for breast cancer survivors with persistent post-treatment pain. Study limitations include the absence of an active control or an analysis to the degree to which greater tricyclic antidepressant use might have contributed to reduced pain and medical utilization.

Reference:

Johannsen, M., Sørensen, J., O’Connor, M., Jensen, A. B., & Zachariae, R. (2017). Mindfulness-Based cognitive therapy (MBCT) is cost-effective compared to a wait-list control for persistent pain in women treated for primary breast cancer-results from a randomized controlled trial. Psycho-Oncology.

[Link to abstract]