School of Medicine and Population Health, Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK.
Division of Psychiatry, University College London, London, UK.
Eur J Neurol. 2024 Aug;31(8):e16317. doi: 10.1111/ene.16317. Epub 2024 Apr 25.
Given the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost-effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life.
A trial-based cost-utility analysis over a 9-month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality-adjusted life years (QALYs) were computed using health utilities generated from the EQ-5D-5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out.
Difference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ-5D-5L were not statistically significantly different between the two arms. The incremental cost-effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life-Revised (MQOL-R) questionnaire. The intervention was cost-effective in a subgroup experiencing medium deterioration in motor neuron symptoms.
Despite the intervention being cost-ineffective in the primary analysis, the significant difference in the effects measured by MQOL-R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services.
鉴于该疾病的退行性本质，患有运动神经元病 (MND) 的人会经历高水平的心理困扰。本研究旨在调查针对该人群特定需求进行调整的接受与承诺疗法 (ACT) 在提高生活质量方面的成本效益。
一项为期 9 个月的基于试验的成本效益分析，比较了 ACT 加常规护理（n=97）与单独常规护理（n=94）的情况，从国家卫生服务的角度出发。在主要分析中，使用 EQ-5D-5L 问卷生成的健康效用计算了质量调整生命年 (QALY)。还进行了敏感性分析和亚组分析。
两臂之间的成本差异具有统计学意义，主要由干预成本驱动。EQ-5D-5L 测量的效果在两臂之间没有统计学上的显著差异。增量成本效益高于英国使用的每增加一个 QALY 超过 20,000 至 30,000 英镑的阈值。然而，当使用 McGill 生活质量修订版 (MQOL-R) 问卷进行测量时，效果差异具有统计学意义。该干预在运动神经元症状中度恶化的亚组中具有成本效益。
尽管主要分析中该干预措施在成本效益上不划算，但 MQOL-R 测量的效果存在显著差异、干预措施的低成本、亚组分析的结果，以及 ACT 被证明可以改善 MND 患者的生活质量，这表明 ACT 可以纳入 MND 临床服务。
