Posted 12.27.2019 | by AMRA

National health care spending for mental disorders in the United States exceeds $200 billion a year. Public health promotion programs that aim to reduce the incidence of mental disorders have the potential to reduce the direct and indirect social and health care costs involved in mental health care.

A previous study showed that a mindfulness-based universal health promotion program called the Life Balance program prevented the emergence of new psychological symptoms in 1 of every 16 people treated at one year follow up. While these results were promising, this study did not address whether the program was cost-effective.

Müller et al. [BMC Public Health] used insurance fund cost data and a measure of anxiety and depressive symptoms to analyze the program’s cost-effectiveness over the course of a year.

The Life Balance program, a mindfulness-based health promotion program implemented in the German state of Baden-Wüerttemberg in 2014, trained 240 health coaches to deliver preventative mental health services at 80 different health care centers. The Life Balance program consisted of 6 weekly 90-minute group sessions drawing on strategies from Acceptance and Commitment Therapy, Dialectical Behavioral Therapy, and Compassion-Focused Therapy.

A total of 583 Life Balance participants who were associated with a statutorily mandated health insurance fund (average age = 50 years; 85% female) agreed to participate in the study. They were compared to a group of 583 controls drawn from the same insurance fund pool and matched on Hospital Anxiety and Depression Scale (HADS) scores, age, sex, health status, activity level, and prior health care costs.

HADS scores were collected at baseline, post-intervention, and 6- and 12-month follow-up. Costs for medications, hospital stays, outpatient and rehabilitation visits, and lost work days were obtained from insurance fund records.

At baseline, the intervention and control groups did not differ on either HADS scores or health care costs. At 12-month follow-up, direct medical costs for Life Balance were $200.91 USD higher than for controls, half of which was due to the $103.52 USD developmental and operating costs of the intervention itself.

Average HADS post-intervention scores were significantly lower for the intervention group (12.4) than controls (14.4). HADS scores of 11-15 indicate moderate levels of anxiety and depression.

Considering direct healthcare costs as well as the cost of lost workdays, the intervention saved an average of $63.27 USD per participant relative to controls, translating into an incremental cost effectiveness ratio of -$32.19 for each one-point improvement on the HADS.

The results show that a mindfulness-based public health promotion program can lower symptoms of anxiety and depression in a general population in a cost-effective manner. There is a 95% chance that the cost effectiveness ratios found in the study fall within estimates of society’s “willingness-to-pay” for degrees of improvement.

This is the first cost effectiveness study of a mindfulness-based universal community-based health promotion program. Universal programs have certain advantages over targeted programs in that they do not incur screening costs, require highly trained professionals, or stigmatize program users.

The study’s limitations include a lack of randomization and reliance on a single outcome measure. Further, reliance on lost work days as the only measure of indirect costs underestimates indirect social cost savings.


Müller, G., Pfinder, M., Schmahl, C., Bohus, M., & Lyssenko, L. (2019). Cost-effectiveness of a mindfulness-based mental health promotion program: Economic evaluation of a nonrandomized controlled trial with propensity score matching. BMC Public Health, 19(1), 1309.

[Link to study]