Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial
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 eval...
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/12/e087414.full |
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| author | David Reeves Calvin Heal Patrick Joseph Doherty Gemma E Shields Adrian Wells Lora Capobianco Anthony Heagerty Deborah Buck Linda M Davies Elizabeth Camacho |
| author_facet | David Reeves Calvin Heal Patrick Joseph Doherty Gemma E Shields Adrian Wells Lora Capobianco Anthony Heagerty Deborah Buck Linda M Davies Elizabeth Camacho |
| author_sort | David Reeves |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-8e12a71addae42c58c79283271d2a8d2 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8e12a71addae42c58c79283271d2a8d22025-01-14T14:50:14ZengBMJ Publishing GroupBMJ Open2044-60552024-12-01141210.1136/bmjopen-2024-087414Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trialDavid Reeves0Calvin Heal1Patrick Joseph Doherty2Gemma E Shields3Adrian Wells4Lora Capobianco5Anthony Heagerty6Deborah Buck7Linda M Davies8Elizabeth Camacho93 Centre for Primary Care, University of Manchester, Manchester, UK7 Centre for Biostatistics, University of Manchester, Manchester, UK2 Department of Health Sciences, University of York, York, UK1 Manchester Centre for Health Economics, University of Manchester, Manchester, UK4 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK4 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK6 Division of Cardiovascular Sciences, University of Manchester, Manchester, UKManchester Centre for Health Economics, The University of Manchester, Manchester, UK1 Manchester Centre for Health Economics, University of Manchester, Manchester, UK1 Manchester Centre for Health Economics, University of Manchester, Manchester, UKObjectives 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.https://bmjopen.bmj.com/content/14/12/e087414.full |
| spellingShingle | David Reeves Calvin Heal Patrick Joseph Doherty Gemma E Shields Adrian Wells Lora Capobianco Anthony Heagerty Deborah Buck Linda M Davies Elizabeth Camacho Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial BMJ Open |
| title | Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial |
| title_full | Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial |
| title_fullStr | Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial |
| title_full_unstemmed | Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial |
| title_short | Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial |
| title_sort | cost effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and or depression analysis of a randomised controlled trial |
| url | https://bmjopen.bmj.com/content/14/12/e087414.full |
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