Mindfulness-Based Self-Help More Effective, Less Costly Depression Treatment

For mild to moderate depression, practitioner-supported mindfulness-based cognitive therapy self-help (MBCT-SH) was found to be superior and more cost-effective than standard care with practitioner-supported cognitive behavioral therapy self-help (CBT-SH). These findings were published in JAMA Psychiatry.

This pragmatic, parallel, superiority randomized clinical trial was conducted at 10 sites in England. Patients (N=410) with mild to moderate depression were randomly assigned in a 1:1 ratio to receive MBCT-SH (n=204) or CBT-SH (n=206). The MBCT-SH intervention relied on The Mindful Way Workbook: An 8-Week Program to Free Yourself from Depression and Emotional Distress and use of the workbook was supported by 6 structured 30-45-minute sessions with a psychosocial well-being practitioner (PWP). Participants were given 16 weeks to complete the workbook and attend sessions. Clinical outcomes were evaluated at 16 and 42 weeks, and cost-effectiveness was assessed using quality-adjusted life-years (QALYs) determined by the European Quality of Life-5 Dimensions-5 Level (EQ-5D-5L) scores.

The MBCT-SH and CBT-SH cohorts comprised of 61% and 62% women, they had median ages of 35 (IQR, 26-45.5) and 32 (IQR, 25-45) years, 86% and 85% were White, and 53% and 51% had moderate depression, respectively.

At 16 weeks, MBCT-SH was associated with greater improvements in 9-item Patient Health Questionnaire (PHQ-9) scores (mean difference [MD], -1.46 points; P =.009), 15-item Five Facet Mindfulness Questionnaire (FFMQ-15) nonjudge subscale (MD, 0.71 points; P =.01), and Generalized Anxiety Disorder 7-item scale (GAD-7) scores (MD, -0.95 points; P =.047) compared with the CBT-SH group.

At 42 weeks, only FFMQ-15 nonjudge subscale scores remained significantly different between groups (P =.03).

A total of 3 serious adverse events occurred in the MBCT-SH group and 0 in the CBT-SH group. All adverse events were unrelated with the intervention. However, 5.5% and 4.1% of the MBCT-SH and CBT-SH groups, respectively, reported lasting negative effects, such as feeling pressure to progress through the workbook and not liking the exercises.

The total average healthcare cost of the MBCT-SH intervention was £944 (SD, £1102)($1133) compared with £1571 (SD, £2754) ($1866) for the CBT-SH intervention, whereas both interventions associated with a QALY improvement of 0.65. Stratified by individual costs, the MBCT-SH intervention was significantly less expensive for health and social care costs (adjusted MD [aMD], -£530; [$636] P =.007) and total costs (aMD, -£526; [$631] P =.007) compared with CBT-SH.

Using a willingness-to-pay threshold of £20,000-£30,000 ($24,000 to $36,000) per QALY, the probability of MBCT-SH being more cost-effective than CBT-SH was above 95%.

This study was limited by the loss to follow-up, in which only 76.0% and 74.8% of the MBCT-SH and CBT-SH groups attended the final follow-up, respectively.

This study found more favorable outcomes at a lower cost for MBCT-SH compared with CBT-SH for the treatment of mild to moderate depression. These data led the study authors to conclude, “[A] novel intervention, practitioner-supported MBCT-SH, was clinically superior in targeting depressive symptom severity at postintervention and cost-effective compared with the criterion standard of practitioner-supported CBT-SH for adults experiencing mild to moderate depression.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.