Business case for psychosocial interventions in clinics: potential for decrease in treatment discontinuation and costs


Author: Ad A Kaptein1, Joyce C Harper2, Grada van den Dool3, Marieke Schoonenberg4, Jesper Smeenk5, Hirad Daneshpour6, Meike Troost6, Lise M van Wijk7, Naomi Tielen8, Ellen Smit9, Joop Laven10, Annemieke Hoek11, Jacky Boivin12

Affiliation: <sup>1</sup> Department of Medical Psychology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.

<sup>2</sup> UCL Institute for Women's Health, 86-96 Chenies Mews, London, England WC1E 6HX, UK.

<sup>3</sup> Nij Linge, Edisonweg 30, 4207 HG Gorinchem, The Netherlands.

<sup>4</sup> Nij Geertgen, Ripseweg 9, 5424 SM Elsendorp, The Netherlands.

<sup>5</sup> Center for Reproduction Brabant - Gynaecology, Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands.

<sup>6</sup> KPMG Health, Laan van Langerhuize 1, 1186 DS Amstelveen, The Netherlands.

<sup>7</sup> Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands; Jade 16, 2371LB Roelofarendsveen, The Netherlands.

<sup>8</sup> Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands; Gerwenseweg 27, 5708 EH Helmond, The Netherlands.

<sup>9</sup> Ferring B.V., Polarisavenue 130, 2132 JX Hoofddorp, The Netherlands.

<sup>10</sup> Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

<sup>11</sup> Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO 30001, 9700 RB Groningen, The Netherlands.

<sup>12</sup> School of Psychology, Cardiff University, 70 Park Place, Cardiff, Wales, CF10 3AT, UK. Electronic address: boivin@cardiff.ac.uk.
Conference/Journal: Reprod Biomed Online
Date published: 2024 May 18
Other:
 Volume ID: 49   ,  Issue ID: 3   ,  Pages: 104113   ,  Special Notes: doi: 10.1016/j.rbmo.2024.104113.   ,  Word Count: 248  
    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.



Keywords: business case; cognitive behavioural therapy; fertility treatment; mindfulness; psychosocial interventions; value-based health care.



PMID: 39043044 DOI: 10.1016/j.rbmo.2024.104113