Abstract
Background: Given the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost-effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life. Methods: A trial-based cost–utility analysis over a 9-month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality-adjusted life years (QALYs) were computed using health utilities generated from the EQ-5D-5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out. Results: Difference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ-5D-5L were not statistically significantly different between the two arms. The incremental cost-effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life-Revised (MQOL-R) questionnaire. The intervention was cost-effective in a subgroup experiencing medium deterioration in motor neuron symptoms. Conclusions: Despite the intervention being cost-ineffective in the primary analysis, the significant difference in the effects measured by MQOL-R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services.
| Original language | English |
|---|---|
| Article number | e16317 |
| Number of pages | 22 |
| Journal | European Journal of Neurology |
| Volume | 31 |
| Issue number | 8 |
| Early online date | 25 Apr 2024 |
| DOIs | |
| Publication status | Published - Aug 2024 |
Funding
R.L.G., M.A.S. and R.J.H. are supported by the NIHR University College London Hospitals Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London. M.Br., T.Y., C.C. and C.J.M. are supported by the NIHR Sheffield Biomedical Research Centre. A.A.\u2010C., V.L. and L.H.G. are supported by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. C.J.M. is an NIHR Research Professor. A.A.\u2010C. is an NIHR Senior Investigator (NIHR202421), and is supported by an EU Joint Programme \u2010 Neurodegenerative Disease Research (JPND) project through the following funding organisations under the aegis of JPND: www.jpnd.eu (United Kingdom, Medical Research Council [MR/L501529/1; MR/R024804/1] and Economic and Social Research Council [ES/L008238/1]). A.A.\u2010C. is also supported through the Motor Neurone Disease Association, My Name'5 Doddie Foundation and the Alan Davidson Foundation. This study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment Programme (grant number 16/81/01) and the Motor Neuron Disease Association (grant number Gould/Jul17/936\u2013794). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. The NIHR commissioned the research and had an initial role in stipulating brief details about the study design, but was otherwise not involved in study design, collection/analysis/interpretation of data or manuscript preparation, as was the Motor Neurone Disease Association.
Keywords
- motor neuron disease
- acceptance and commitment therapy
- RCT
- cost-effectiveness
- health related quality of life