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Public health mindfulness program saves on mental health costs

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 […]

November 27th, 2019|News|

MBSR shows cost benefit for fibromyalgia, fewer sick days

Posted 08.30.2019 | by AMRA

Fibromyalgia is a chronic disorder affecting approximately 10,000,000 Americans. The disorder presents with symptoms of widespread musculoskeletal pain, fatigue, and mood, sleep, and cognitive difficulties. The cause of fibromyalgia is unknown, and its treatment is largely palliative, consisting of medication to reduce pain and inflammation, graded physical exercise and/or cognitive-behavioral therapy. The disorder incurs a wide variety of costs including high rates of unemployment, sick leave, disability claims, and direct medical care utilization.

Perez-Aranda et al. [Journal of Clinical Medicine] compared the cost-effectiveness and clinical utility of adjunctive Mindfulness-Based Stress Reduction (MBSR) to a previously validated comparator intervention and treatment-as-usual in the treatment of fibromyalgia.

The researchers randomly assigned 225 fibromyalgia patients recruited from a Spanish hospital to one of three treatment interventions: 1) MBSR + treatment-as-usual, 2) FibroQoL + treatment-as-usual, and 3) treatment-as-usual alone. MBSR was delivered using the standard 8-week group protocol with minimal adaptations. FibroQoL is a fibromyalgia intervention with previously demonstrated superiority to treatment-as-usual. It consists of 8 weekly 2-hour group sessions that include fibromyalgia psycho-education, relaxation, and self-hypnosis to help patients control pain and visualize a future pain-free life. Treatment-as-usual involved prescription medications for pain, inflammation, depression, and anxiety, along with recommendations for daily exercise.

Cost-utility data was only available for a final sample of 204 participants (98% female; average age = 53 years). Analyses were performed separately for the full intention-to-treat sample and for 107 patients who attended at least 6 of the 8 intervention sessions and their 12-month follow-up appointments.

Self-ratings of quality-of-life were obtained at baseline and 12 months using the EuroQol EQ-5D to assess disease impingement on mobility, self-care, and activities of daily living, as well as […]

August 30th, 2019|News|

Cost-savings of mindfulness program compared to routine care for mental health

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 […]

December 28th, 2018|News|

Cost savings of Mindfulness Based Cognitive Therapy in cancer care

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 […]

June 22nd, 2017|News|

Workplace mindfulness intervention may lower overall healthcare costs

Posted 09.26.2016 | by AMRA

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Healthcare costs in the United States rose to over 17% of the Gross Domestic Product in 2015. Employers are increasingly turning to workplace-based lifestyle interventions to control employee healthcare costs. Mindfulness-based interventions (MBIs) are sometimes offered in workplaces to enhance employee self-care and decrease illness-causing stress. How well do workplace-based MBIs succeed in lowering employee healthcare utilization costs?

Using a quasi-experimental design, Klatt et al. [Complementary Therapies in Medicine] retrospectively analyzed 5-year healthcare utilization and the associated costs for participants in a workplace-based MBI and a workplace-based didactic diet-and-exercise program. The researchers then compared these utilization rates and costs with those of matched controls drawn from a health care database.

A sample of 170 faculty and staff members from a large Midwestern university was recruited and randomly assigned to either a MBI or the diet-and-exercise (DE) intervention. The participants were selected, in part, on the basis of their high C-reactive protein levels (3.0-10.0 mg/ml), which are a known risk factor in cardiovascular disease. The MBI was an 8-week program modeled after MBSR, but truncated to fit a lunch hour schedule. The weekly workplace-based group meetings lasted 1 hour, recommended home practice was 20 minutes per day, yoga consisted of standing and chair yoga, and a 2-hour retreat replaced the usual “all day” session. The DE intervention consisted of a series of 8, 1-hour-long, group didactic sessions focusing on nutrition, diet, and exercise along with associated home readings.

After the experiment was concluded, an additional cohort of 258 “controls” was selected from the university health plan database by matching the study participants as closely as possible on age, gender, relative health risk, and prior healthcare utilization. […]

September 26th, 2016|News|

MBSR cuts Canadians’ use of healthcare up to $279 per person

Posted 05.22.2015 | by AMRA

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Rising health care costs threaten to strain federal, state, and family budgets. Can helping patients become more proactive in their health care help to contain costs? Knight et al. [Mindfulness] investigated whether MBSR produces long-term health cost savings through stress reduction and enhanced personal responsibility for well-being.

The researchers examined physician visit and laboratory utilization data for 1,730 Canadians (75% female, mean age = 45) who had taken an MBSR course at a Toronto health center. Data was obtained from the Ontario Health Insurance Program (OHIP) administrative database.

MBSR participant healthcare utilization was compared with similar utilization data from three comparison cohorts also drawn from the OHIP database and matched on variables such as age, sex, illness severity and complexity of care. The data were analyzed at one and two years prior to MBSR involvement and at one and two years after participation.

MBSR participants were heavy service utilizers prior to starting MBSR, generating more than twice the costs and nearly twice the medical visits of the matched comparison groups. In the year after MBSR, participants showed a decrease in costs (between $244 to $279 per person), physician visits, and laboratory usage, while the cost for the comparison groups increased ($3 to $18 per person). Most of these differences vanished when the data were analyzed for the full two years after MBSR, except for slightly lower laboratory utilization in the MBSR group.

The study shows decreased healthcare utilization costs in the first year after people participate in MBSR. The study is limited by a lack of random assignment and the non-inclusion of data for inpatient stays, emergency room visits, and medication.

Reference:

Knight, R. W., Bean, J., […]

May 22nd, 2015|News|

Mindfulness therapy holds up to antidepressent treatment for depression

Posted 05.18.2015 | by AMRA

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Mindfulness-Based Cognitive Therapy (MBCT) is an eight-week group psychosocial intervention combining mindfulness training with cognitive therapy elements to reduce the risk of relapse and remission in major depressive illness. Prior research demonstrates that MBCT reduces relapse and recurrence in patients with three or more depressive episodes, but MBCT’s efficacy relative to conventional antidepressant therapy has never been tested. This is important because many patients would prefer not to take medication if an effective alternative were available. Kuyken et al. [The Lancet] directly compared MBCT to pharmacotherapy in a randomized, controlled, single-blind clinical trial.

The researchers randomly assigned 424 primarily Caucasian, middle-aged British men and women with a history of three or more major depressive episodes and who were currently receiving maintenance antidepressant therapy to a continued maintenance antidepressant therapy (ADM) condition or a MBCT with support for tapering or discontinuing medication (MBCT-TS) condition. MBCT-TS patients were supported for reducing or stopping their medication in the sixth week of the MBCT protocol. ADM patients were encouraged to continue their medication throughout the two-year study.

Eighty-seven percent of MBCT-TS patients discontinued or tapered their medication, while 76% of the ADM patients continued their medication. Participants were assessed at baseline and five times over 24 months for signs of depressive relapse and recurrence and other illness-related outcomes using clinical interviews and self-report measures.

There was no significant difference in relapse or recurrence between the treatments: 44% of the MBCT-TS group relapsed, and 47% of the ADM group relapsed. Both rates are lower than those typically found for patients with multiple prior depressive episodes. There were also no significant differences between treatments in residual symptoms, depression-free days, medical […]

May 18th, 2015|News|

Web-based MBI combats work stress and burnout

Posted: 08.20.2014 | by AMRA

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Occupational stress is not only harmful to employees, but is also costly to employers in terms of increased health-care expenses and decreased employee attendance, morale, and performance. Mindfulness-based interventions (MBIs) may have an important role to play in combatting occupational stress, but MBSR programs are time-intensive and often challenging to implement in the workplace, especially on a scale expansive enough to benefit large corporations.

Aikins et al. [Journal of Occupational and Environmental Medicine] developed an abbreviated MBI modeled after MBSR that was delivered on a web-based virtual classroom platform. The intervention makes use of a live instructor, webinar-and-email technology, and a printed workbook/practice guide to deliver 7, 1 hour-long, virtual classes and support 10.8 hours of home-based practice. The durations of the body scan, meditation, and yoga sessions were shortened to accommodate the hour-long format, there was no daylong retreat, and workplace-relevant material was included in the syllabus.

Eighty-nine Dow Chemical Company employees were randomly assigned to either the MBI or a wait-list control. Only 66 participants completed the study, due in part to the 6 MBI and 10 wait-list control subjects who never attended a class after being initially assigned to their groups. MBI participants significantly improved their mindfulness (as measured by the Five-Facet Mindfulness Questionnaire), resilience, and physical, emotional, and cognitive vigor, and decreased their perceived stress compared with wait-list controls.

Treatment gains were maintained or continued to improve at six-month follow-up, with the exception of a small, non-significant rise in perceived stress. MBI participants reported significant decreases in high-stress days, burnout, and fast-food consumption, as well as increases in fruit and vegetable consumption.

Eighty-seven percent of the participants rated the program as […]

August 11th, 2014|News|