Cost-Utility of Attachment-Based Compassion Therapy (ABCT) for Fibromyalgia Compared to Relaxation: A Pilot Randomized Controlled Trial

Abstract

A recent study has supported the efficacy of Attachment-Based Compassion Therapy (ABCT) compared to relaxation (REL) for the management of fibromyalgia (FM). The main objective of this paper is to examine the cost-utility of ABCT compared to REL in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs. Forty-two Spanish patients with FM received 8 weekly group sessions of ABCT or REL. Data collection took place at pre-and 3-month follow-up. Cost-utility of the two treatment groups (ABCT vs. REL) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory). Data analyses were computed from a completers, ITT, and per protocol approach. Data analysis from the healthcare perspective revealed that those patients receiving ABCT exhibited larger improvements in quality of life than those doing relaxation, while being less costly 3 months after their 8-week treatment program had ended (completers: incremental cost M, 95% CI = €−194.1 (−450.3 to 356.1); incremental effect M, 95% CI = 0.023 QALYs (0.010 to 0.141)). Results were similar using an ITT approach (incremental cost M, 95% CI = €−256.3 (−447.4 to −65.3); incremental effect M, 95% CI = 0.021 QALYs (0.009 to 0.033)). A similar pattern of results were obtained from the per protocol approach. This RCT has contributed to the evidence base of compassion-based interventions and provided useful information about the cost-utility of ABCT for FM patients when compared to relaxation. However, the small sample size and short follow-up period limited the generalizability of the findings.

Attachment style and parental bonding: Relationships with fibromyalgia and alexithymia

“…First, when working with patients with FM, clinical attention should be paid to not only the management of pain symptoms but also impairments in affect regulation and attachment dynamics. The use of group therapeutic interventions like the Attachment-Based Compassion Therapy that includes formal practices of mindfulness and visualizations based on self-compassion and the attachment style that was generated in childhood, could be an effective and also cheaper strategy for the treatment of patients with FM [61].…”

Economic Evaluations of Mindfulness-Based Interventions: a Systematic Review

“…Thus, there were 41 studies included at this stage. At the final level of review for inclusion, 13 additional studies were excluded because the meditation component was mixed with other types of interventions (D’Amico et al, 2020 ; Doyle et al, 2019 ; Gaupp et al, 2020 ; Ljótsson et al, 2011 , 2014 ; Mercer et al, 2016 ; Orme-Johnson & Herron, 1997 ; Stahl et al, 2015 ; Sun et al, 2021 ), they were feasibility studies with only intervention costs (Hennelly et al, 2020 ; Tulloh et al, 2018 ), the effectiveness outcome included for cost-effectiveness calculation was not a health-related outcome (e.g., teaching competency as the effectiveness outcome; Crane et al, 2020 ), or the meditation intervention was not an MBI (Herron, 2011 ), leaving 28 studies meeting the criteria to be included in this study (Fig. 1 ).…”

Economic evaluations of educational, physical, and psychological treatments for fibromyalgia: a systematic review with meta-analysis

“…All studies were randomized controlled trials. 8,10,11,14,25,26,28,34,35,49,55 Most studies were performed from both the healthcare and societal perspectives; 11,14,25,26,28,35,49 2 were performed only from the healthcare perspective 8,34 and 2 only from the societal perspective. 10,55 The time horizon was shorter than 9 months in 5 studies, 8,11,14,26,28 12 months in 5 studies, 10,25,34,35,55 and 24 months in 1 study.…”

“…49 Two studies conducted only a costeffectiveness analysis, 34,49 6 studies conducted only a costutility analysis, 10,11,25,26,35,55 and 3 studies conducted both analyses. 8,14,28 Nine studies measured utilities to calculate QALYs: 7 studies using the EuroQoL-5 Dimension (EQ-5D), 8,11,14,25,26,28,35 1 study using the Short-Form 6 Dimension (SF-6D), 55 and 1 study using the Maastricht Utility Measurement Questionnaire. 10 The other clinical outcome measured was the impact of fibromyalgia, assessed in 5 studies using the Fibromyalgia Impact Questionnaire.…”

“…10 The other clinical outcome measured was the impact of fibromyalgia, assessed in 5 studies using the Fibromyalgia Impact Questionnaire. 8,14,28,34,49 Healthcare costs were assessed in all studies, 8,10,11,14,25,26,28,34,35,49,55 patient and family costs were assessed in 6 studies, 10,11,14,25,49,55 and lost productivity costs were also assessed in 6 studies. 10,14,26,28,35,55 The included studies compared a psychological intervention with an educational discussion group, 10 pharmacological treatment, 26,28 mindfulness-based stress reduction, 35 another psychological intervention, 8 waiting list, 10,14 and usual care.…”