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

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‐make...

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