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

Background This study aimed to evaluate the costs and cost-effectiveness of third-generation therapies for treating depressive and anxiety symptoms. Methods We conducted a systematic review and meta-analysis, searching SCOPUS, Web of Science, PsycINFO, EMBASE, and MEDLINE. Randomized controlled trials reporting costs or cost-effectiveness of third-generation therapies for depression or anxiety were included. 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. Results 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; I²=47.8%). 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). Conclusions 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.