Costs and cost-effectiveness of interventions based on third generation therapy models to treat symptoms of depression and anxiety: A systematic review and meta-analysis

<b>Background: </b>Depression and anxiety are the most prevalent mental health problems globally, and while there are currently a number of effective interventions for both mental health problems, information on the cost-effectiveness and costs associated with these interventions is limited. Especially, in recent interventions such as third generation therapies, there is limited information on the cost-effectiveness and costs associated with these interventions.<b>Objective: </b>This study aimed to evaluate the costs and cost-effectiveness of third-generation therapies for treating depressive and anxiety symptoms.<b>Methods: </b>We conducted a systematic review and meta-analysis, searching SCOPUS, Web of Science, PsycINFO, EMBASE, and MEDLINE from 1980 to March 12, 2024. Randomized controlled trials reporting costs or cost-effectiveness of third-generation therapies for depression or anxiety were included. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the ECOBIAS checklist. Meta-analysis of quality-adjusted life years (QALYs) was conducted using Hedges' g and random-effects models. Costs were standardized to US dollars and adjusted for inflation.<b>Results: </b>Twenty studies met inclusion criteria, with 10 suitable for meta-analysis. Meta-analysis showed no significant difference in QALY improvement between third-generation therapies and control conditions (Hedges' g = 0.015, 95% CI: -0.001 to 0.032; P=0.070). Moderate heterogeneity was observed (I²=47.8%, P=0.032). Subgroup analyses by therapy type (Mindfulness-Based Cognitive Therapy, Behavioral Activation, Acceptance and Commitment Therapy, and Problem-Solving Therapy) also yielded non-significant results. High risk of bias was observed in 50% of studies due to narrow perspective, in 45% due to omission of cost measurement, and in 46% due to insufficient information on discounting. Publication bias was detected (Egger's test: P = 0.011). Our study found no significant difference in the average cost per person between receiving an intervention based on third-generation therapies (M = $2,494.6; SD = $7,090.9) and receiving a control condition (M = $1,912.0; SD = $2,081.3) (t = 0.253; p=0.802).<b>Conclusions:</b> Our study found that interventions based on third-generation therapies do not entail significant additional costs compared to control conditions. However, the interventions based on third-generation therapies did not improve the QALYs of the participants more than the control group.<br>

研究背景：
抑郁与焦虑是全球范围内最普遍的心理健康问题，尽管目前已有多种针对这两类心理问题的有效干预手段，但关于这些干预措施的成本与成本效益的相关信息仍较为匮乏。尤其是针对近年来兴起的第三代疗法（third-generation therapies）这类干预手段，相关成本与成本效益的研究数据尤为有限。
研究目的：
本研究旨在评估第三代疗法用于改善抑郁与焦虑症状的成本及成本效益。
研究方法：
本研究采用系统综述与荟萃分析方法，检索了1980年至2024年3月12日期间SCOPUS、Web of Science、PsycINFO、EMBASE及MEDLINE数据库中的相关文献。纳入标准为报道了针对抑郁或焦虑的第三代疗法的成本或成本效益的随机对照试验。由两名独立评审员独立完成文献筛选、数据提取，并采用ECOBIAS偏倚风险清单评估研究偏倚风险。以Hedges' g统计量结合随机效应模型对质量调整生命年（quality-adjusted life years, QALYs）开展荟萃分析。将所有成本统一换算为美元，并进行通货膨胀调整。
研究结果：
本研究共纳入符合标准的20项研究，其中10项可用于荟萃分析。荟萃分析结果显示，第三代疗法与对照干预措施在质量调整生命年改善方面无显著差异（Hedges' g=0.015，95%置信区间：-0.001~0.032；P=0.070）。研究间存在中度异质性（I²=47.8%，P=0.032）。按疗法类型分组的亚组分析（包括正念认知疗法（Mindfulness-Based Cognitive Therapy）、行为激活疗法、接纳与承诺疗法及问题解决疗法）同样未得到显著结果。50%的研究存在偏倚风险较高的问题，具体原因为研究视角局限；45%的研究存在未纳入成本测量的问题；46%的研究缺乏贴现相关的足够信息。本研究检测到存在发表偏倚（Egger检验：P=0.011）。此外，本研究发现，接受第三代疗法干预的受试者人均平均成本（均值M=2494.6美元，标准差SD=7090.9美元）与接受对照干预的受试者（均值M=1912.0美元，标准差SD=2081.3美元）之间无显著差异（t=0.253，p=0.802）。
研究结论：
本研究结果表明，与对照干预措施相比，基于第三代疗法的干预手段并未带来显著额外成本。但与此同时，第三代疗法干预并未比对照组更能提升受试者的质量调整生命年。