Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs.
Study Goal
The researchers aimed to determine whether providing CBT or mindfulness to women seeking fertility treatment adds value from a VBHC perspective by assessing clinical outcomes and intervention costs.
Results Summary
CBT reduced anxiety by 12%, depression by 40%, and improved fertility quality of life by 6%, with a 6-percentage-point increase in clinical pregnancy rates. Mindfulness reduced anxiety by 8%, depression by 45%, and improved fertility quality of life by 21%, with a 19-percentage-point increase in clinical pregnancy rates. Potential cost savings were €1.2 million for CBT and €11 million for mindfulness annually.
Population
Women seeking fertility treatment.
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
cognitive behavioural therapy (CBT) | decrease | anxiety | women seeking fertility treatment | 12% | had 12% lower | #1 |
cognitive behavioural therapy (CBT) | decrease | depression | women seeking fertility treatment | 40% | had 40% lower | #2 |
cognitive behavioural therapy (CBT) | increase | fertility quality of life | women seeking fertility treatment | 6% | had 6% higher | #3 |
cognitive behavioural therapy (CBT) | increase | clinical pregnancy rates | women seeking fertility treatment | six percentage points | difference in clinical pregnancy rates was six percentage points | #4 |
cognitive behavioural therapy (CBT) | decrease | fertility discontinuation rates | women seeking fertility treatment | 10 percentage points | difference in fertility discontinuation rates was 10 percentage points | #5 |
mindfulness | decrease | anxiety | women seeking fertility treatment | 8% | had 8% lower | #6 |
mindfulness | decrease | depression | women seeking fertility treatment | 45% | had 45% lower | #7 |
mindfulness | increase | fertility quality of life | women seeking fertility treatment | 21% | had 21% higher | #8 |
mindfulness | increase | clinical pregnancy rate | women seeking fertility treatment | 19 percentage points | difference in mean clinical pregnancy rate was 19 percentage points | #9 |
cognitive behavioural therapy (CBT) | increase | total cost savings | women seeking fertility treatment | €1.2 million per year | Potential total cost savings was about €1.2 million per year | #10 |
mindfulness | increase | total cost savings | women seeking fertility treatment | €11 million | Potential total cost savings was about €11 million | #11 |
cognitive behavioural therapy (CBT) | increase | return on investment | women seeking fertility treatment | 30.7% | Corresponding return on investment for CBT was 30.7% | #12 |
mindfulness | increase | return on investment | women seeking fertility treatment | 288% | Corresponding return on investment for mindfulness was 288% | #13 |
RESEARCH QUESTION: From a value-based healthcare (VBHC) perspective, does an assessment of clinical outcomes and intervention costs indicate that providing cognitive behavioural therapy (CBT) or mindfulness to women seeking fertility treatment add value compared with no such intervention? DESIGN: Proof-of-concept business case based on a VBHC perspective that considers clinical outcomes and costs. Potential effects on psychological and fertility outcomes were based on existing research. Cost outcomes were estimated with a costing model for the Dutch fertility treatment setting. RESULTS: Thirty-two studies were identified; 13 were included. Women who received CBT had 12% lower anxiety, 40% lower depression and 6% higher fertility quality of life; difference in clinical pregnancy rates was six percentage points (CBT [30.2%]; control [24.2%]); difference in fertility discontinuation rates was 10 percentage points (CBT [5.5%]; control [15.2%]). Women who received training in mindfulness had 8% lower anxiety, 45% lower depression and 21% higher fertility quality of life; difference in mean clinical pregnancy rate was 19 percentage points (mindfulness [44.8%]; control [26.0%]). Potential total cost savings was about €1.2 million per year if CBT was provided and €11 million if mindfulness was provided. Corresponding return on investment for CBT was 30.7%, and for mindfulness 288%. Potential cost benefits are influenced by the assumed clinical pregnancy rates; such data related to mindfulness were limited to one study. CONCLUSIONS: The provision of CBT or mindfulness to women seeking fertility treatment could add value. Higher quality primary studies are needed on the effect of mindfulness on clinical pregnancy rates.