Posted 12.28.2018 | by AMRA

Mental health problems are costly to society both in terms of treatment-related expenses and lost productivity. If research shows that two treatments are equally effective in reducing symptoms, it seems reasonable to ask which of the two is more cost effective.

A recent Swedish study showed that a group-based mindfulness intervention was equally as effective as standard care (mostly individual-based cognitive behavioral therapy) in reducing symptoms of anxiety and depression. Saha et al. [British Journal of Psychiatry] evaluated the previously published Swedish study to determine the cost-effectiveness of group-based mindfulness interventions as compared to the costs of standard care.

The original study randomly assigned 215 Swedish patients (average age = 42 years; 85% female) diagnosed with depression, anxiety, stress, or adjustment disorders who were being treated at 16 different primary care health centers to either a mindfulness-based intervention (MBI) or standard care.

The MBI was offered in two-hour weekly group sessions over eight weeks and based on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy. The majority of standard care patents (76%) received individual cognitive-behavioral therapy for an average of 6.3 sessions.

Intervention and control participants were equally likely to be taking antidepressant and/or anti-anxiety medications, so that group differences cannot be attributed to medication effects. The researchers compared the two groups in terms of 1) total health care costs over the course of 8 weeks (the costs of therapy, medication, and medical visits), 2) self-reported quality of life improvement in terms of mobility, self-care, activities of daily living, pain, suffering, anxiety, and depression, and 3) productivity in terms of patient reported sick leave and hours worked.

The results showed that the group-based mindfulness intervention cost about $130 less per patient over the course of 8 weeks than standard care consisting of mostly individual therapy and counseling. The cost difference was not due to differences in medication use or healthcare utilization, but to the fact that group treatments require less professional time than individual treatments. The groups did not differ significantly in terms of patient reported quality of life or work productivity.

This study shows that over the course of 8 weeks, a group-based mindfulness intervention was less expensive than standard Swedish primary care. A prior analysis showed that the mindfulness intervention was roughly equivalent to standard care in terms of symptom outcomes. The results are important because they point to a potential cost savings gained from group treatments compared to individual treatments without inferior outcomes.

In the United States, 30% of patients with diagnosable depression receive no treatment at all. Many do not have adequate insurance, and there are not enough individual therapists to meet the need. Finding more affordable ways to deliver care and taking advantage of opportunities to utilize therapist time more efficiently is important.

The study is limited by its eight-week length, as there may be other cost and productivity differences that emerge over a longer period of time. It is also limited by relying on patient reports of medication use and medical visits rather than making use of more objective pharmacy, clinic, and insurance records.

Reference:

Saha, S., Jarl, J., Gerdtham, U. -G., Sundquist, K., & Sundquist, J. (2018). Economic evaluation of mindfulness group therapy for patients with depression, anxiety, stress and adjustment disorders compared with treatment as usual. The British Journal of Psychiatry.

[Link to abstract]