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 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 of 332 CR patients in the UK with elevated symptoms of anxiety and/or depression, compared group-based MCT to UC. The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was 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 (ICER).
Results:
In the primary cost-effectiveness analysis, MCT intervention was dominant; with a cost saving (net cost -219; 95% CI -£1,446, £1,007) and QALY gains (net QALY 0.015; 95% CI -0.015, 0.045). However, there is high level of uncertainty in the estimates. At a threshold of £30,000 per QALY MCT intervention was around 76% likely to be cost-effective.
Conclusions:
Results suggest intervention may be cost saving and health increasing, however, findings are uncertain and are subject to limitations. Further research should aim to reduce the uncertainty in the findings (e.g., with larger sample sizes) and explore potential longer-term economic benefits associated with MCT in this setting.
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 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 of 332 CR patients in the UK with elevated symptoms of anxiety and/or depression, compared group-based MCT to UC. The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was 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 (ICER).
Results:
In the primary cost-effectiveness analysis, MCT intervention was dominant; with a cost saving (net cost -219; 95% CI -£1,446, £1,007) and QALY gains (net QALY 0.015; 95% CI -0.015, 0.045). However, there is high level of uncertainty in the estimates. At a threshold of £30,000 per QALY MCT intervention was around 76% likely to be cost-effective.
Conclusions:
Results suggest intervention may be cost saving and health increasing, however, findings are uncertain and are subject to limitations. Further research should aim to reduce the uncertainty in the findings (e.g., with larger sample sizes) and explore potential longer-term economic benefits associated with MCT in this setting.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| Publication status | Accepted/In press - 18 Nov 2024 |
Keywords
- cardiac rehabilitation
- anxiety and depression
- cost-effectiveness
- cost-utility
- economic evaluation
- metacognitive therapy