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Cited by 39Mindfulness and Compassion InterventionsHealth Systems, Economic Evaluations, Quality of LifeDigital Mental Health Interventions

Are acceptance and mindfulness‐based interventions ‘value for money’? Evidence from a systematic literature review

Open access
Duarte, Rui, Lloyd, Annette, Kotas, Eleanor, Andronis, Lazaros, White, Ross·2019·British Journal of Clinical Psychology
DOI 10.1111/bjc.12208PMC PMC6588093
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Abstract

Objectives: Acceptance and mindfulness‐based interventions (A/ MBI s) are recommended for people with mental health conditions. Although there is a growing evidence base supporting the effectiveness of different A/ MBI s for mental health conditions, the economic case for these interventions has not been fully explored. The aim of this systematic review was to identify and appraise all available economic evidence of A/ MBI s for the management of mental health conditions. Methods: Eight electronic bibliographic databases ( MEDLINE , MEDLINE In‐Process & Other Non‐Indexed Citations, EMBASE , Web of Science, NHS Economic Evaluation Database ( EED ), Database of Abstracts of Reviews of Effects ( DARE ), Health Technology Assessment ( HTA ) database, and EconLit) were searched for relevant economic evaluations published from each database's inception date until November 2017. Study selection, quality assessment, and data extraction were carried out according to published guidelines. Results: Ten relevant economic evaluations presented in 11 papers were identified. Seven of the included studies were full economic evaluations (i.e., costs and effects assessed), and three studies were partial economic evaluations (i.e., only costs were considered in the analysis). The A/ MBI s that had been subjected to economic evaluation were acceptance and commitment therapy ( ACT ), dialectical behaviour therapy ( DBT ), mindfulness‐based cognitive therapy ( MBCT ), and mindfulness‐based stress reduction ( MBSR ). In terms of clinical presentations, the evaluation of cost‐effectiveness of A/ MBI s has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively. Three out of seven full economic evaluations observed that A/ MBI s were cost‐effective for the management of mental health conditions. Nevertheless, the heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can currently be made. Conclusion: This first substantive review of economic evaluations of A/ MBI s indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/ MBI s for mental health conditions. Practitioner points: The findings of the review provide information that may be relevant to mental health service commissioners and decision‐makers as all economic evidence available on acceptance and mindfulness‐based interventions for mental health conditions is summarized. Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date. Heterogeneity in the specific forms of acceptance and mindfulness‐based interventions may limit generalizability of the findings. The number of health economic evaluations relating to acceptance and mindfulness‐based interventions remains relatively small. Further research in this area is required.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review identified 10 economic evaluations (in 11 papers) of acceptance and mindfulness-based interventions (A/MBIs) for mental health conditions. It found that only 3 of 7 full economic evaluations suggested A/MBIs were cost-effective, while the 3 partial evaluations reported cost-savings, and heterogeneity limited firm conclusions.

Key findings

  • Ten relevant economic evaluations were included: 7 full economic evaluations and 3 partial economic evaluations. The A/MBIs evaluated were ACT, DBT, MBCT, and MBSR, with depression (3 evaluations) and emotionally unstable personality disorder (EUPD; 4 evaluations) the most studied conditions.
  • Three of seven full economic evaluations observed A/MBIs to be cost-effective; one found MBCT not cost-effective (dominated by maintenance antidepressant treatment), and the remaining full evaluations were inconclusive. The three partial economic evaluations reported cost-savings.
  • Reported economic results included DBT mean saving of £1,741 per participant (Amner, 2012), DBT saving of AUS $5,927 per patient over 6 months (Pasieczny & Connor, 2011), and MBCT saving of AUS $83 per depression-free day and AUS $87,313 per DALY averted from a health care perspective (Shawyer et al., 2016).
  • Other full evaluations reported ICERs such as €66,450 per QALY gained for MBCT for medically unexplained symptoms (health care perspective; van Ravesteijn et al., 2013) and $33,579 per QALY gained for ACT versus a null comparator (health care perspective; Finnes et al., 2017).

Methods

  • Systematic review following PRISMA and Cochrane guidance for narrative summary of health economic studies. Eight electronic databases (MEDLINE, MEDLINE In-Process, EMBASE, Web of Science, NHS EED, DARE, HTA, EconLit) were searched from inception to 22 November 2017, with no language restriction, plus hand-searching of reference lists.
  • Full and partial economic evaluations of A/MBIs for adults with DSM-5 mental health disorders were eligible. Two reviewers independently screened records, data extraction was checked by a second reviewer, and methodological quality was assessed with the CHEC-list.
  • A narrative synthesis summarized study characteristics, quality, and findings; no meta-analysis was performed.

Limitations

  • The paper states that heterogeneity of included populations, interventions, and economic evaluation study types limits the extent to which firm conclusions can be made, and that more research is needed before firm conclusions can be reached on cost-effectiveness.
  • The paper notes that not all studies presented incremental analyses, those that did used different willingness-to-pay thresholds, several evaluations depended on relatively small trials, and sensitivity analyses were often not clearly described. No economic models evaluating long-term cost-effectiveness were identified.
  • Evident from the text: three included studies were partial economic evaluations with weaker quality assessment scores, DBT was assessed only in EUPD, and one study (Shawyer et al., 2016) did not discount outcomes despite a 24-month time horizon.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/bjc.12208

Cites

59 of 60 references verified1 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 94 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The A/MBIs subjected to economic evaluation were ACT, DBT, MBCT, and MBSR.

    “The A/MBIs that had been subjected to economic evaluation were acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness‐based cognitive therapy (MBCT), and mindfulness‐based stress reduction (MBSR).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Cost-effectiveness evaluation of A/MBIs has been more focused on depression and emotional unstable personality disorder, with three and four economic evaluations respectively.

    “In terms of clinical presentations, the evaluation of cost‐effectiveness of A/MBIs has been more focused on depression and emotional unstable personality disorder with three and four economic evaluations, respectively.”
    • Also stated in: § Practitioner points · plain
      “Evidence relating to the cost‐effectiveness and cost‐saving potential of acceptance and mindfulness‐based interventions is focused mainly on depression and emotional unstable personality disorder to date.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Ten relevant economic evaluations presented in 11 papers were identified.

    “Ten relevant economic evaluations presented in 11 papers were identified.”
    • Also stated in: § Results · plain
      “The remaining 10 studies presented in 11 articles formed the final set of reviewed evidence”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The systematic search identified all available economic evidence of A/MBIs for the management of mental health conditions.
  • Findingown data

    Three included studies were partial economic evaluations (only costs considered).

    “three studies were partial economic evaluations (i.e., only costs were considered in the analysis)”
    Quote in the paperNot a substantial claim
  • Findingown data

    Seven of the included studies were full economic evaluations (costs and effects assessed).

    “Seven of the included studies were full economic evaluations (i.e., costs and effects assessed)”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 22
  • May combine two claims. 36

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sensitivity analyses feature in four of the full economic evaluations as a way of dealing with uncertainty associated with a range of parameters.

    “Sensitivity analyses feature in four of the full economic evaluations as a way of dealing with uncertainty associated with a range of parameters”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Kuyken et al. (2015a) found that in terms of QALYs, costs were higher in the MBCT group and outcomes slightly worse, suggesting that MBCT was dominated by maintenance antidepressant treatment.

    “In terms of QALYs, costs were higher in the MBCT group and outcomes slightly worse, suggesting that MBCT was dominated by maintenance antidepressant treatment”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kuyken, et al. (2015a)

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    Findingown data

    Knight et al. (2015) was a partial economic evaluation and met fewer quality assessment criteria than the full economic evaluations.

    “However, the study by Knight et al. (2015) was a partial economic evaluation and met a lesser number of criteria in the quality assessment than the full economic evaluations.”
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    • cites Knight et al. (2015)

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    Findingcitation

    Priebe et al. (2012) reported a modest incremental cost of £36 to achieve a one percentage point reduction in the incidence of self-harm, with no explicit statement on the probability of cost-effectiveness.

    “Priebe et al. (2012) reporting a modest incremental cost of £36 to achieve a one percentage point reduction in the incidence of self‐harm; however, no explicit statement on the probability of cost‐effectiveness was reported.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Priebe et al. (2012)

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    Findingcitation

    Pasieczny and Connor (2011) reported a positive impact of DBT on both cost and outcomes, with a mean saving of AUS $5,927 per patient over a 6-month period and a mean reduction in suicide attempts of 1.34 per patient.

    “Pasieczny and Connor (2011) adopting a CCA approach reported a positive impact of DBT on both cost and outcomes, with a mean saving of AUS $5,927 per patient over a 6‐month period and mean reduction in suicide attempts of 1.34 per patient, respectively.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pasieczny and Connor (2011)

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    Findingown data

    Amner (2012) and Wagner et al. (2014) were partial economic evaluations and met fewer quality assessment criteria than the other studies assessing DBT for EUPD.

    “However, these studies (Amner, 2012; Wagner et al., 2014) were partial economic evaluations and met a lesser number of criteria in the quality assessment than the other studies assessing DBT for EUPD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Amner, 2012

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    • cites Wagner et al., 2014

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    Findingcitation

    In Kuyken et al. (2008), the use of MBCT was considered justified only if the willingness to pay for improvements in the proportion of patients who relapse was $1,000 or above, and results were considered inconclusive.

    “In the study by Kuyken et al. (2008), the use of MBCT was considered to be justified but only if the WTP for improvements in the proportion of patients who relapse was $1,000 or above and results were considered inconclusive.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kuyken et al. (2008)

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    Findingcitation

    Kuyken et al. (2015a) reported that the MBCT group resulted in more costs and less effectiveness than the maintenance antidepressant treatment group.

    “the more recent study by Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a) reported that the MBCT group resulted in more costs and less effectiveness than maintenance antidepressant treatment group.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

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    Findingreasoning

    In Amner (2012) and Wagner et al. (2014), there was no assessment of health outcomes and pre-intervention data were collected retrospectively.

    “there was no assessment of health outcomes and pre‐intervention data were collected retrospectively.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Amner (2012)

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    • cites Wagner et al. (2014)

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    Findingown data

    Kuyken et al. (2015a) and Shawyer et al. (2016) are similar in terms of criteria met in the quality assessment; however, Shawyer et al. (2016) did not discount outcomes as recommended for economic evaluations with a time horizon longer than 12 months.

    “The studies by Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a) and Shawyer et al. (2016) are similar in terms of the criteria met in the quality assessment; however, the study by Shawyer et al. (2016) did not discount the outcomes as recommended it should be done in economic evaluations with a time horizon longer than 12 months.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

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    • cites Shawyer et al. (2016)

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    Findingcitation

    Participants in the intervention arm of Shawyer et al. (2016) spent less time on average in a major depressive state and incurred less DALYs relative to comparator treatment.

    “participants in the intervention arm of the trial spent less time, on average, in a major depressive state and as result incurred less DALYs relative to the comparator treatment (Shawyer et al., 2016).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shawyer et al. (2016)

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    Findingcitation

    Amner (2012) and Wagner et al. (2014) reported that the cost of treating participants with EUPD reduced after DBT intervention when compared with treatment prior to DBT.

    “whilst both the studies by Amner (2012) and Wagner et al. (2014) reported that the cost of treating participants with EUPD reduced after DBT intervention when compared with treatment prior to DBT”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Amner (2012)

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    • cites Wagner et al. (2014)

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    Findingcitation

    The findings indicated either marginal borderline evidence that MBCT reduced the risk of relapse of a depressive episode relative to comparator treatment (Kuyken et al., 2008), or no difference at all (Kuyken et al., 2015a, 2015b).

    “The findings also indicated either marginal borderline evidence that MBCT reduced the risk of relapse of a depressive episode relative to the comparator treatment (Kuyken et al., 2008), or no difference at all (Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al., 2015a; Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Morant, et al., 2015b).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Kuyken et al., 2008

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    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

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    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Morant, et al. (2015b)

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    Findingcitation

    Pasieczny and Connor (2011) revealed that participants consumed fewer health and social care resources on the DBT arm of the trial and benefited from better health outcomes on the back of reduced incidence of suicide attempts.

    “the study revealed that participants consumed fewer health and social care resources on the DBT arm of the trial and benefited from better health outcomes on the back of reduced incidence of suicide attempts.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pasieczny and Connor (2011)

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  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    The level of uncertainty around the cost impact of the intervention led the authors of Priebe et al. (2012) to conclude that while DBT was shown to be effective in reducing the incidence of self-harm, there was a possibility for higher treatment costs overall.

    “The level of uncertainty around the cost impact of the intervention led the authors to conclude that whilst DBT was shown to be effective in reducing the incidence of self‐harm, there was a possibility for higher treatment costs overall.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Priebe et al. (2012)

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    Findingcitation

    Priebe et al. (2012) evidenced a reduction in self-harm in participants receiving DBT intervention arm compared to the treatment as usual arm, and the mean cost per patient of the DBT intervention was higher than the comparator, albeit not statistically significant.

    “the study of Priebe et al. (2012) evidenced a reduction in self‐harm in participants receiving DBT intervention arm compared to the treatment as usual arm, and the mean cost per patient of the DBT intervention was higher than the comparator, albeit not statistically significant.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Priebe et al. (2012)

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    Findingnone given

    Nine of the ten studies had a study time horizon of 12 months or more, with two of the three studies assessing MBCT for depression having a 24-month follow-up.

    “It is positive that nine of the ten studies had a study time horizon of 12 months or more, with two of the three studies assessing MBCT for depression having a 24‐month follow‐up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    The identified studies employed a variety of measures to capture positive changes in mental health outcomes and improved health-related quality of life, with the latter being translated into QALYs.

    “the identified studies employed a variety of measures to capture positive changes in mental health outcomes and improved health‐related quality of life, with the latter being translated into QALYs.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    This is the first review to systematically synthesize research evidence relating to the cost-effectiveness of A/MBIs.

    “This is the first review to systematically synthesize research evidence relating to the cost‐effectiveness of A/MBIs.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Six of the ten studies were reported to have undertaken sensitivity analysis to test various parameter uncertainties, but the data and methods used to characterize the level of uncertainty were either not described or not clearly detailed.

    “whilst six of the ten studies were reported to have undertaken sensitivity analysis to test various parameter uncertainties, the data and methods used to characterize the level of uncertainty were either not described or not clearly detailed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    The Kuyken et al. (2015a) study superseded the Kuyken et al. (2008) study and found the intervention not to be cost-effective.

    “This has been superseded by the study of Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a), which found the intervention not to be cost‐effective.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

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    • cites Kuyken et al. (2008)

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  • May combine two claims.

    Findingown data

    Three out of seven full economic evaluations suggest A/MBIs to be cost-effective, while the three partial economic evaluations considered A/MBIs to be cost-saving versus a range of comparator interventions.

    “Three out of seven full economic evaluations suggest A/MBIs to be cost‐effective, whilst the three partial economic evaluations considered A/MBIs to be cost‐saving versus a range of comparator interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The results of the included economic evaluations varied with one study suggesting A/MBIs not to be cost-effective while other studies were inconclusive.

    “The results of the included economic evaluations varied with one study suggesting A/MBIs not to be cost‐effective whilst other studies were inconclusive.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    MBSR and MBCT significantly improved depressive symptoms, anxiety, stress, and physical functioning for patients with cancer, chronic pain, cardiovascular disease, somatic diseases, and depression compared to waiting list control and treatment as usual.

    “An overview of systematic review and meta‐analysis of randomized control trials (RCTs) found that MBSR and MBCT significantly improved depressive symptoms, anxiety, stress, and physical functioning for patients with cancer, chronic pain, cardiovascular disease, somatic diseases, and depression when compared to waiting list control and to treatment as usual (Gotink et al., 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gotink et al., 2015

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  • Classified as probably not a substantial claim.

    Interpretationreasoning

    More research is needed before firm conclusions can be reached on the cost-effectiveness of A/MBIs for mental health conditions.

    “This first substantive review of economic evaluations of A/MBIs indicates that more research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.”
    • Also stated in: § Conclusion · plain
      “More research is needed before firm conclusions can be reached on the cost‐effectiveness of A/MBIs for mental health conditions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MBCT is recommended in the United Kingdom as an approach to prevent depressive relapse among patients with three prior episodes of depression.

    “MBCT as an approach to prevent depressive relapse among patients with three prior episodes of depression is recommended in the United Kingdom (NICE 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites NICE 2009

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    Premisecitation

    DBT is effective in reducing self-destructive behaviours and enhancing treatment adherence.

    “A meta‐analysis indicated that DBT was effective in reducing self‐destructive behaviours and enhancing the extent to which participants adhered to treatment (Panos, Jackson, Hasan, & Panos, 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Panos, Jackson, Hasan, & Panos, 2014

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The methodological quality of included economic evaluations was assessed using the CHEC-list.

    “The methodological quality of the economic evaluations identified was assessed using the Consensus on Health Economic Criteria checklist (CHEC‐list) (Evers, Goossens, de Vet, van Tulder, & Ament, 2005), which is recommended for appraising the methodological quality of economic evaluations (Higgins & Green, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Evers, Goossens, de Vet, van Tulder, & Ament, 2005

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    • cites Higgins & Green, 2011

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    This systematic review follows PRISMA reporting guidelines and Cochrane Handbook recommendations for narrative summary of health economic studies.

    “This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) reporting guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009) and the good practice recommendations for narrative summary of health economic studies outlined in the Cochrane Handbook for Systematic Reviews (Shemilt et al., 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Moher, Liberati, Tetzlaff, & Altman, 2009

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    • cites Shemilt et al., 2011

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    Premisecitation

    ACT offers promise to reduce distress associated with a range of physical and mental health difficulties.

    “Similarly, a meta‐analysis of ACT studies concluded that ACT offers promise to reduce distress associated with a range of physical and mental health difficulties (A‐tjak et al., 2015).”
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    • cites A‐tjak et al., 2015

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    One author extracted data, and a second author checked the data for accuracy.

    “One author extracted the data, and a second author checked the data for accuracy.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two reviewers independently assessed all records based on title and abstract according to inclusion criteria.

    “Two reviewers independently assessed all records based on their title and abstract according to the inclusion criteria (Table 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Quality assessment was carried out by one reviewer and checked for agreement by a second reviewer.

    “Quality assessment was carried out by one reviewer and checked for agreement by a second reviewer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A/MBIs are complex psycho-social treatment packages with interrelated components that have a synergizing effect.

    “As with other forms of complex intervention, A/MBIs are complex psycho‐social treatment packages with interrelated components that have a synergizing effect (Demarzo et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Demarzo et al., 2015

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    Interpretationnone given

    van Ravesteijn et al. (2013) used a willingness-to-pay threshold of €80,000 per QALY gained, which is higher than the willingness-to-pay per QALY gained in other countries.

    “However, van Ravesteijn et al. (2013) used a WTP of €80,000 per QALY gained, which is higher than the WTP per QALY gained in other countries.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites van Ravesteijn et al. (2013)

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    Interpretationcitation

    The results relating to cost in Pasieczny and Connor (2011) have a degree of uncertainty, as the mean reduction of AUS $5,927 per patient on the DBT arm related specifically to a 6-month time horizon, and the authors reported the intervention group to be more costly than the comparator treatment group for those patients who continued to receive the intervention for a further 6 months.

    “However, the results relating to cost have a degree of uncertainty, as the mean reduction of AUS $5,927 per patient on the DBT arm related specifically to a 6‐month time horizon, and the authors reported the intervention group to be more costly than the comparator treatment group for those patients who continued to receive the intervention for a further 6 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pasieczny and Connor (2011)

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  • May combine two claims.

    Interpretationreasoning

    Two evaluations focusing on MBCT's effect on depression (Kuyken et al., 2008; Kuyken et al., 2015a; Kuyken et al., 2015b) presented results from both societal and health/personal social care perspectives, strengthening their external validity from this perspective.

    “Indeed, it is noteworthy that two of evaluations focusing on MBCT's effect on depression (Kuyken, et al., 2008; Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al., 2015a; Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Morant, et al., 2015b) presented results in this way, thus strengthening their external validity from this perspective.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Kuyken, et al., 2008

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    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

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    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Morant, et al. (2015b)

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  • May combine two claims.

    Interpretationreasoning

    In Priebe et al. (2012), the incremental cost to achieve a one percentage point reduction in the incidence of self-harm was relatively low, but the small sample size and lack of statistical power to yield a statistically significant difference in cost create a level of uncertainty around cost-effectiveness, which was not explored by the authors.

    “So whilst the incremental cost to achieve a one percentage point reduction in the incidence of self‐harm was relative low, the small sample size and lack of statistical power to yield a statistically significant difference in cost create a level of uncertainty around cost‐effectiveness, which was not explored by the authors.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Priebe et al. (2012)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    It is difficult to draw any direct comparisons between the remaining three studies that evaluated the impact of A/MBIs on non-specific mental health conditions.

    “It is difficult to draw any direct comparisons between the remaining three studies that evaluated the impact of A/MBIs on non‐specific mental health conditions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Empirical evidence suggests that psychological well-being and social interaction are salient elements for people with mental health problems, though such elements are not included in prominent generic measures of quality of life, which instead focus on domains such as usual activities, physical mobility, and pain.

    “empirical evidence suggests that psychological well‐being and social interaction are salient elements for people with mental health problems, though such elements are not included in prominent generic measures of QoL, which instead focus on domains such as usual activities, physical mobility, and pain (Chisholm, Healey, & Knapp, 1997).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chisholm, Healey, & Knapp, 1997

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  • Classified as probably not a substantial claim.

    Premisecitation

    QALYs offer a generic measure of quality of life that can facilitate comparisons across areas and conditions, including mental health problems.

    “QALYs offer a generic measure of quality of life (QoL) that can facilitate comparisons across areas and conditions, including mental health problems (Brazier, 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Brazier, 2008

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    With the exception of Kuyken et al. (2015a) and Shawyer et al. (2016), the economic evaluations in the review were dependent on the results of relatively small trials, which may affect the internal validity of the results.

    “With the exception of the Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a) and Shawyer et al. (2016) studies, the economic evaluations in the current review were dependent on the results of relatively small trials, which may affect the internal validity of the results.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kuyken, Hayes, Barrett, Byng, Dalgleish, Kessler, Lewis, Watkins, Brejcha, et al. (2015a)

      Not checked in the free run.

    • cites Shawyer et al. (2016)

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The study parameters were wide in scope, which successfully facilitated a search of literature to inform the knowledge base of cost-effectiveness of A/MBIs.

    “The study parameters were therefore wide in scope, which successfully facilitated a search of literature to inform the knowledge base of cost‐effectiveness of A/MBIs.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    There were a number of technical issues with the three studies examining the cost-effectiveness of MBCT on depression, but there was a relatively high level of internal and external validity across these studies.

    “whilst there were a number of technical issues with the three studies examining the cost‐effectiveness of MBCT on depression, there was a relatively high level of internal and external validity across these studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Each part of the review, including study identification, selection, quality assessment, and data extraction, was carried out in line with PRISMA and Centre for Reviews and Dissemination guidelines.

    “Each part of the review, including study identification, selection, quality assessment, and data extraction, was carried out in line with PRISMA (Moher et al., 2009) and Centre for Reviews and Dissemination guidelines (NHS CRD 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Moher et al., 2009

      Not checked in the free run.

    • cites NHS CRD 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Consistent with previous reviews that have evaluated the efficacy of A/MBIs, the studies included in the current review focused on a range of conditions and interventions.

    “Consistent with previous reviews that have evaluated the efficacy of A/MBIs, the studies included in the current review focused on a range of conditions (Gotink et al., 2015; Khoury et al., 2013) and interventions (Cavanagh et al., 2014; Veehof et al., 2016; Vøllestad et al., 2012).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Gotink et al., 2015

      Not checked in the free run.

    • cites Khoury et al., 2013

      Not checked in the free run.

    • cites Cavanagh et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    As the results are presented separately by mental health condition, the health economic evaluation for DBT can be easily disaggregated from the analyses relating to other forms of A/MBIs.

    “As the results are presented separately by mental health condition, the health economic evaluation for DBT can be easily disaggregated from the analyses relating to other forms of A/MBIs.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    No constraints were set on the economic study type and limited criteria on the population of interest.

    “No constraints were set on the economic study type and limited criteria on the population of interest.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    NICE (2009) recommended MBCT as a treatment for people who are currently well but had experienced three or more previous depressive episodes.

    “NICE (2009) recommended MBCT as a treatment for people who are currently well but had experienced three or more previous depressive episodes.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites NICE (2009)

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Two recent reviews of MBIs have highlighted that there is a need to better monitor the quantity and quality of between-session mindfulness practice, which is purported to be an important process of change.

    “Two recent reviews of MBIs have highlighted that there is a need to better monitor the quantity and quality of between‐session mindfulness practice, which is purported to be an important process of change (Lloyd, White, Eames, & Crane, 2017; Parsons, Crane, Parsons, Fjorback, & Kuyken, 2017).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lloyd, White, Eames, & Crane, 2017

      Not checked in the free run.

    • cites Parsons, Crane, Parsons, Fjorback, & Kuyken, 2017

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NICE's decision was made based on one cost-effectiveness analysis (Kuyken et al., 2008), which produced an inconclusive result.

    “This decision was made based on one cost‐effectiveness analysis (Kuyken et al., 2008), which produced an inconclusive result.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites NICE (2009)

      Not checked in the free run.

    • cites Kuyken et al., 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Given the relatively poor implementation of MBCT for depression, the findings of the review provide information that may be relevant to decision-makers responsible for implementation of the NICE guideline.

    “Given the relatively poor implementation of MBCT for depression (Crane & Kuyken, 2013), the findings of the review provide information that may be relevant to decision‐makers responsible for implementation of this NICE guideline.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Crane & Kuyken, 2013

      Not checked in the free run.

52 of 52

  • The paper relies on this without support.

    The systematic search identified all available economic evidence of A/MBIs for the management of mental health conditions.

    “The aim of this systematic review was to identify and appraise all available economic evidence of A/MBIs for the management of mental health conditions.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(2, 78) = 25.14reported p < .001 · recomputed p < .001

    “F(2, 78) = 25.14, p < .001”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two probabilities reported for van Ravesteijn at the same threshold

    Minor

    The results narrative gives a 57% probability of cost-effectiveness at €80,000 per QALY, whereas Table 4 and the discussion give 55% at that threshold.

1 of 1

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 6

  1. Fjorback L., 2012, Mindfulness therapy for Bodily distress syndrome: Economic evaluation alongside a randomized trial, Journal of Psychosomatic Research, 72, 480
  2. Higgins J. P. T., 2011, Cochrane handbook for systematic reviews of interventions version 5.1.0
  3. Holmes M., 2007, A probabilistic cost‐effectiveness analysis of psychological therapies including dialectical behaviour therapy for borderline personality disorder, Journal of Mental Health Policy and Economics, 10, S18
  4. NICE, 2009, Depression in adults: Recognition and management. Clinical guideline 90
  5. Shemilt I., 2011, Cochrane handbook for systematic reviews of interventions version 5.1.0, 449
  6. Roijen L. H., 2015, Cost‐effectiveness and cost‐utility of Shortterm inpatient dialectical behavior therapy for chronically parasuicidal BPD (Young) adults, Journal of Mental Health Policy and Economics, 18, S19

Cited by

Sorted by citations

Related

Authors
Duarte, R., Lloyd, A., Kotas, E., Andronis, L., & White, R.
Affiliations
  • University of Liverpool (GB)
  • NHS Greater Glasgow and Clyde (GB)
  • University of Warwick (GB)
Corresponding author
Duarte, Rui
ORCID
Venue
British Journal of Clinical Psychology
Publisher
Wiley
Published
2018-11-29
Volume
58
Issue
2
Pages
187-210
ISSN
  • 0144-6657 (ISSN-L)
  • 2044-8260
DOI
10.1111/bjc.12208
PMC
PMC6588093
OpenAlex
W2902777321
Semantic Scholar
e42eb08bb3c61d7894db754ad443c9af874bcb70
Cited by
39
References
59
Citations by year
2025: 5 · 2024: 7 · 2023: 6 · 2022: 7 · 2021: 6 · 2020: 4 · 2019: 4
FWCI
0.59
Type
journal article
Language
en
Open access
Licence
Locations
  • British Journal of Clinical Psychology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
acceptance and commitment therapy, dialectical behavior therapy, mindfulness-based cognitive therapy, mindfulness-based stress reduction, cost-effectiveness, economic evaluation, mental illness, depression, value for money, cost reduction
MeSH terms
Cost-Benefit Analysis, Female, Humans, Male, Mindfulness

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

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