Shields Gemma E, Camacho Elizabeth, Davies Linda M, Doherty Patrick Joseph, Reeves David, Capobianco Lora, Heagerty Anthony, Heal Calvin, Buck Deborah, Wells Adrian
Manchester Centre for Health Economics, University of Manchester, Manchester, UK
Manchester Centre for Health Economics, University of Manchester, Manchester, UK.
BMJ Open. 2024 Dec 20;14(12):e087414. doi: 10.1136/bmjopen-2024-087414.
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.
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.
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.
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.
心血管疾病（CVD）的负担正在增加。心脏康复（CR）是一种针对CVD患者在发生心脏事件、诊断或干预后提供的复杂干预措施，旨在降低死亡率和发病率。这项试验内经济评估的目的是从英国卫生和社会护理的角度比较元认知疗法（MCT）加常规护理（UC）与UC的成本效益。
在英国进行了一项多中心、单盲、随机对照试验（ISRCTN74643496），纳入332名有焦虑和/或抑郁症状加重的CR患者，将基于小组的MCT与UC进行比较。成本效益分析的主要结局是质量调整生命年（QALYs）。主要分析的时间范围是12个月的随访。使用多重填补法对缺失数据进行填补。通过概率性自抽样法探索不确定性。敏感性分析测试了研究设计和假设对增量成本效益比的影响。
在主要成本效益分析中，MCT干预占主导地位，具有成本节约（净成本-219英镑；95%CI-1446英镑，1007英镑）和QALY增益（净QALY 0.015；95%CI-0.015，0.045）。然而，估计值存在高度不确定性。在每QALY 30000英镑的阈值下，约76%的MCT干预可能具有成本效益。
结果表明该干预可能既节约成本又增进健康；然而，研究结果存在不确定性且有局限性。进一步的研究应旨在减少研究结果的不确定性（例如，通过更大的样本量），并探索在这种情况下与MCT相关的潜在长期经济效益。
