Pérez-Aranda Adrián, D'Amico Francesco, Feliu-Soler Albert, McCracken Lance M, Peñarrubia-María María T, Andrés-Rodríguez Laura, Angarita-Osorio Natalia, Knapp Martin, García-Campayo Javier, Luciano Juan V
Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
J Clin Med. 2019 Jul 20;8(7):1068. doi: 10.3390/jcm8071068.
Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost-utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention ("FibroQoL") and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost-utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms ( < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.
纤维肌痛（FM）是一种常见的慢性致残性疼痛综合征，意味着高昂的医疗成本。需要对FM潜在有效的治疗方法进行经济学评估。本研究的目的是分析与辅助多成分干预措施（“纤维肌痛生活质量干预方案”）和常规治疗（TAU）相比，基于正念减压疗法（MBSR）作为FM患者常规治疗附加疗法的成本效益。我们在一项为期12个月的随机对照试验的同时进行了经济学评估；成本效益分析纳入了225名患者中的204名（每个研究组68名，占90.1%）的数据，评估是从政府和公共医疗系统的角度进行的。主要结局指标包括用于评估质量调整生命年（QALYs）和健康相关生活质量改善情况的欧洲五维度健康量表（EQ-5D-5L），以及用于估计直接和间接成本的客户服务收据清单（CSRI）。还计算了增量成本效益比（ICERs）。进行了两项敏感性分析（意向性分析，ITT，和符合方案分析，PPA）。结果表明，与其他研究组相比，MBSR实现了成本的显著降低（在完成者样本中P<0.05），尤其是在间接成本和初级医疗服务方面。在ITT样本中，与TAU相比，MBSR还产生了显著的增量效果（ΔQALYs = 0.053，P<0.05，其中QALYs代表质量调整生命年）。总体而言，我们的研究结果支持在西班牙公共医疗背景下，MBSR相对于纤维肌痛生活质量干预方案和TAU具有更高的效率。
