Evidence map›Paper›PMID 39806675›Full record

Trial reportBMJ open2024

Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and/or depression: analysis of a randomised controlled trial.

Gemma E Shields, Elizabeth Camacho, Linda M Davies, Patrick Joseph Doherty, David Reeves, Lora Capobianco, Anthony Heagerty, Calvin Heal, Deborah Buck, Adrian Wells

Abstract readRandomized Controlled TrialMulticenter Study
In one paragraph

Trial report in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Gemma E ShieldsManchester Centre for Health Economics, University of Manchester, Manchester, UK gemma.shields@manchester.ac.uk.ORCID http://orcid.org/0000-0003-4869-7524
Elizabeth CamachoManchester Centre for Health Economics, University of Manchester, Manchester, UK.ORCID http://orcid.org/0000-0001-9574-7710
Linda M DaviesManchester Centre for Health Economics, University of Manchester, Manchester, UK.
Patrick Joseph DohertyDepartment of Health Sciences, University of York, York, UK.ORCID http://orcid.org/0000-0002-1887-0237
David ReevesCentre for Primary Care, University of Manchester, Manchester, UK.ORCID http://orcid.org/0000-0001-6377-6859
Lora CapobiancoGreater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Anthony HeagertyDivision of Cardiovascular Sciences, University of Manchester, Manchester, UK.
Calvin HealCentre for Biostatistics, University of Manchester, Manchester, UK.
Deborah BuckManchester Centre for Health Economics, University of Manchester, Manchester, UK.ORCID http://orcid.org/0000-0002-2271-6400
Adrian WellsGreater Manchester Mental Health NHS Foundation Trust, Manchester, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe burden of cardiovascular disease (CVD) is increasing. Cardiac rehabilitation (CR) is a complex intervention offered to patients with CVD, following a heart event, diagnosis or intervention, and it aims to reduce mortality and morbidity. The objective of this within-trial economic evaluation was to compare the cost-effectiveness of metacognitive therapy (MCT) plus usual care (UC) to UC, from a health and social care perspective in the UK.

methodsA multicentre, single-blind, randomised controlled trial (ISRCTN74643496) was conducted in the UK involving 332 patients with CR with elevated symptoms of anxiety and/or depression and compared group-based MCT with UC. The primary outcome of the cost-effectiveness analysis was quality-adjusted life-years (QALYs). The time horizon of the primary analysis was a 12-month follow-up. Missing data were imputed using multiple imputation. Uncertainty was explored by probabilistic bootstrapping. Sensitivity analyses tested the impact of the study design and assumptions on the incremental cost-effectiveness ratio.

resultsIn the primary cost-effectiveness analysis, MCT intervention was dominant, with a cost-saving (net cost -£219; 95% CI -£1446, £1007) and QALY gains (net QALY 0.015; 95% CI -0.015, 0.045). However, there is a high level of uncertainty in the estimates. At a threshold of £30 000 per QALY, MCT intervention of around 76% was likely to be cost-effective.

conclusionsResults suggest that intervention may be cost-saving and health-increasing; however, findings are uncertain and subject to limitations. Further research should aim to reduce the uncertainty in the findings (eg, with larger sample sizes) and explore potential longer-term economic benefits associated with MCT in this setting.

Indexed as

AnxietyCardiac RehabilitationCardiovascular DiseasesCognitive Behavioral TherapyDepressionMetacognitionAgedCost-Benefit AnalysisFemaleHumansMaleMiddle AgedQuality-Adjusted Life YearsSingle-Blind MethodUnited KingdomAnxiety disordersCARDIOLOGYDepression & mood disordersHEALTH ECONOMICSREHABILITATION MEDICINE

Identifiers

PMID39806675
PMCPMC11667381

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.