TY - JOUR
AU - W. Abu-Ashour
AU - R. Audas
AU - J. M. Gamble
AU - J. Hawboldt
AU - J. E. M. Sale
A1 - 
AB - BACKGROUND: Major depressive disorder (MDD) is a chronic condition with high relapse rates affecting patients and health systems. Cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are strategies for relapse prevention, but their comparative long-term cost-effectiveness remains unclear. METHODS: We developed a cohort-based Markov model with three health states, depressive episode, remission, and death, to compare MBCT and CBT in adults with MDD. The model used a lifetime horizon, six-month cycles, with healthcare payer and societal perspectives. Costs included direct medical and productivity losses discounted at 1.5%. Health-state utilities were drawn from published sources. Incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were estimated at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses, plus scenario analyses with alternative horizons and discount rates, assessed uncertainty. RESULTS: In the base case, MBCT was associated with 14.71 QALYs at a cost of $543,861, while CBT yielded 15.07 QALYs at $549,487. CBT provided an incremental 0.37 QALYs at $5625 higher cost, producing an ICER of $15,266 per QALY gained, well below both thresholds. NMB favored CBT ($204,242 vs. $191,443 at $50,000; $957,971 vs. $926,746 at $100,000). Sensitivity analyses highlighted remission- and depression-related costs as main drivers. Probabilistic analyses showed CBT optimal in 56% of simulations at $50,000 and 61% at $100,000, with MBCT preferred at lower thresholds. CONCLUSION: CBT may be more cost-effective relative to MBCT for relapse prevention in MDD, though differences are modest. MBCT remains a competitive alternative where CBT access is limited.
AD - School of Pharmacy, Memorial University, Health Sciences Centre, St. John's, NL, A1B 3V6, Canada. Electronic address: wmaa75@mun.ca.; Faculty of Medicine, Memorial University, Health Sciences Centre, St. John's, NL, A1B 3X5, Canada. Electronic address: raudas@mun.ca.; School of Pharmacy, University of Waterloo, 10A Victoria Street S, Kitchener, ON N2G 2C5, Canada. Electronic address: jm.gamble@uwaterloo.ca.; School of Pharmacy, Memorial University, Health Sciences Centre, St. John's, NL, A1B 3V6, Canada. Electronic address: hawboldt@mun.ca.; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, 4th Floor - 155 College Street, Toronto, ON, M5T 3M6, Canada; Department of Surgery, Faculty of Medicine, University of Toronto, 5th Floor - 149 College Street, Toronto, ON, M5B 1W8, Canada. Electronic address: joanna.Sale@unityhealth.to.
AN - 41671643
BT - Psychiatry Res
C5 - Financing & Sustainability
DA - Apr
DO - 10.1016/j.psychres.2026.116996
DP - NLM
ET - 20260204
JF - Psychiatry Res
LA - eng
N2 - BACKGROUND: Major depressive disorder (MDD) is a chronic condition with high relapse rates affecting patients and health systems. Cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are strategies for relapse prevention, but their comparative long-term cost-effectiveness remains unclear. METHODS: We developed a cohort-based Markov model with three health states, depressive episode, remission, and death, to compare MBCT and CBT in adults with MDD. The model used a lifetime horizon, six-month cycles, with healthcare payer and societal perspectives. Costs included direct medical and productivity losses discounted at 1.5%. Health-state utilities were drawn from published sources. Incremental cost-effectiveness ratios (ICERs) and net monetary benefit (NMB) were estimated at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses, plus scenario analyses with alternative horizons and discount rates, assessed uncertainty. RESULTS: In the base case, MBCT was associated with 14.71 QALYs at a cost of $543,861, while CBT yielded 15.07 QALYs at $549,487. CBT provided an incremental 0.37 QALYs at $5625 higher cost, producing an ICER of $15,266 per QALY gained, well below both thresholds. NMB favored CBT ($204,242 vs. $191,443 at $50,000; $957,971 vs. $926,746 at $100,000). Sensitivity analyses highlighted remission- and depression-related costs as main drivers. Probabilistic analyses showed CBT optimal in 56% of simulations at $50,000 and 61% at $100,000, with MBCT preferred at lower thresholds. CONCLUSION: CBT may be more cost-effective relative to MBCT for relapse prevention in MDD, though differences are modest. MBCT remains a competitive alternative where CBT access is limited.
PY - 2026
SN - 0165-1781
SP - 116996
ST - A cost-utility analysis of mindfulness-based cognitive therapy versus cognitive behavioral therapy for major depressive disorder relapse prevention in primary care
T1 - A cost-utility analysis of mindfulness-based cognitive therapy versus cognitive behavioral therapy for major depressive disorder relapse prevention in primary care
T2 - Psychiatry Res
TI - A cost-utility analysis of mindfulness-based cognitive therapy versus cognitive behavioral therapy for major depressive disorder relapse prevention in primary care
U1 - Financing & Sustainability
U3 - 10.1016/j.psychres.2026.116996
VL - 358
VO - 0165-1781
Y1 - 2026
ER -