Shields, Gemma E, Camacho, Elizabeth, Davies, Linda M et al. (7 more authors) (2024) Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression:analysis of a randomised controlled trial. BMJ Open. e087414. ISSN 2044-6055
Abstract
OBJECTIVES: The burden of cardiovascular disease (CVD) is increasing. Cardiac rehabilitation (CR) is a complex intervention offered to patients with CVD, following a heart event, diagnosis or intervention, and it aims to reduce mortality and morbidity. The objective of this within-trial economic evaluation was to compare the cost-effectiveness of metacognitive therapy (MCT) plus usual care (UC) to UC, from a health and social care perspective in the UK. METHODS: A multicentre, single-blind, randomised controlled trial (ISRCTN74643496) was conducted in the UK involving 332 patients with CR with elevated symptoms of anxiety and/or depression and compared group-based MCT with UC. The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was a 12-month follow-up. Missing data were imputed using multiple imputation. Uncertainty was explored by probabilistic bootstrapping. Sensitivity analyses tested the impact of the study design and assumptions on the incremental cost-effectiveness ratio. RESULTS: In the primary cost-effectiveness analysis, MCT intervention was dominant, with a cost-saving (net cost -£219; 95% CI -£1446, £1007) and QALY gains (net QALY 0.015; 95% CI -0.015, 0.045). However, there is a high level of uncertainty in the estimates. At a threshold of £30 000 per QALY, MCT intervention of around 76% was likely to be cost-effective. CONCLUSIONS: Results suggest that intervention may be cost-saving and health-increasing; however, findings are uncertain and subject to limitations. Further research should aim to reduce the uncertainty in the findings (eg, with larger sample sizes) and explore potential longer-term economic benefits associated with MCT in this setting.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2024. |
Keywords: | Humans,Cost-Benefit Analysis,Cardiac Rehabilitation/economics,Female,Male,Quality-Adjusted Life Years,Single-Blind Method,Middle Aged,Anxiety/therapy,Cognitive Behavioral Therapy/economics,Depression/therapy,Aged,United Kingdom,Metacognition,Cardiovascular Diseases/economics |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Depositing User: | Pure (York) |
Date Deposited: | 21 Jan 2025 18:18 |
Last Modified: | 21 Feb 2025 00:10 |
Published Version: | https://doi.org/10.1136/bmjopen-2024-087414 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1136/bmjopen-2024-087414 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:222136 |
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Filename: e087414.full.pdf
Description: Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial
Licence: CC-BY 2.5