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.
Highlights
We extend the results of Montero-Marin et al [15] by examining the 3-month cost-utility of Attachment-Based Compassion Therapy (ABCT) compared to Relaxation in terms of gains in quality-adjusted life years (QALYs) from a healthcare perspective
To sum up, taking into account the study limitations—inclusion of a small sample size per study arm, the lack of properly trained therapists offering ABCT, and the short length of the follow-up period—our results should be interpreted with caution
In order to better evaluate the efficiency of ABCT for a public health system or society, in general, a longer study of at least six months to one year would be needed
Summary
Under the umbrella term “fourth wave” [1], there is a group of therapies with their origin in European existential psychotherapy and related humanistic approaches that go beyond symptom improvement to enhancing well-being These approaches include loving-kindness and compassion meditation, as well as related approaches such as positive psychology programs, dignity- and gratitude-promoting approaches, meaning-centered therapy, forgiveness-oriented techniques, and spiritually-informed therapies [1]. Loving-kindness meditation (LKM; metta), compassion meditation (CM; karuna), sympathetic joy (mudita), and equanimity (upekkha) are the four immeasurables that can be cultivated during meditation practice. Practices of both LKM and CM are inherent to all Buddhist traditions, but have particular prominence in Mahayana Buddhist schools [2]. LKM and compassion-based interventions (CBIs) have been shown to be effective for treating a considerable range of mental health issues in both clinical and healthy adult and non-adult populations [2]
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