***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Our aim was to assess cost-effectiveness of mindfulness-based cognitive therapy ( MBCT ) compared with enhanced usual care ( EUC ) in treating patients with persistent medically unexplained symptoms(MUS ) . METHODS A full economic evaluation with a one year time horizon was performed from a societal perspective . Costs were assessed by prospect i ve cost diaries . Health-related Quality of Life was measured using SF-6D . Outcomes were costs per Quality -Adjusted Life Year ( QALY ) . Bootstrap simulations were performed to obtain mean costs , QALY scores and incremental cost-effectiveness ratios ( ICERs ) . RESULTS  MBCT participants ( n=55 ) had lower hospital costs and higher mental health care costs than patients who received EUC ( n=41 ) . Mean bootstrapped costs  for MBCT were € 6269 , and € 5617 for EUC ( 95 % uncertainty interval for difference : -€1576 ; € 2955 ) . QALYs were 0.674 for MBCT and 0.663 for EUC . MBCT was on average more effective and more costly than EUC , result ing in an ICER of € 56,637 per QALY gained . At a willingness to pay of € 80,000 per QALY , the probability that MBCT is cost-effective is 57 % . CONCLUSION Total costs were not statistically significantly different between MBCT and EUC . However , MBCT seemed to cause a shift in the use of health care re sources as mental health care costs were higher and hospital care costs lower in the MBCT condition . Due to the higher drop-out in the EUC condition the cost-effectiveness of MBCT might have been underestimated . The shift in health care use might lead to more effective care for patients with persistent MUS . The longer-term impact of MBCT for patients with persistent MUS needs to be further studied Summary Background Depression is a common , debilitating , and costly disorder . Many patients request psychological therapy , but the best- evidence d therapy — cognitive behavioural therapy (CBT)—is complex and costly . A simpler therapy — behavioural activation (BA)—might be as effective and cheaper than is CBT . We aim ed to establish the clinical efficacy and cost-effectiveness of BA compared with CBT for adults with depression . Methods In this r and omised , controlled , non-inferiority trial , we recruited adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder from primary care and psychological therapy services in Devon , Durham , and Leeds ( UK ) . We excluded people who were receiving psychological therapy , were alcohol or drug dependent , were acutely suicidal or had attempted suicide in the previous 2 months , or were cognitively impaired , or who had bipolar disorder or psychosis or psychotic symptoms . We r and omly assigned participants ( 1:1 ) remotely using computer-generated allocation ( minimisation used ; stratified by depression severity [ Patient Health Question naire 9 ( PHQ-9 ) score of < 19 vs ≥19 ] , antidepressant use , and recruitment site ) to BA from junior mental health workers or CBT from psychological therapists . R and omisation done at the Peninsula Clinical Trials Unit was concealed from investigators . Treatment was given open label , but outcome assessors were masked . The primary outcome was depression symptoms according to the PHQ-9 at 12 months . We analysed all those who were r and omly allocated and had complete data ( modified intention to treat [ mITT ] ) and also all those who were r and omly allocated , had complete data , and received at least eight treatment sessions ( per protocol [ PP ] ) . We analysed safety in the mITT population . The non-inferiority margin was 1·9 PHQ-9 points . This trial is registered with the ISCRTN registry , number IS RCT N27473954 . Findings Between Sept 26 , 2012 , and April 3 , 2014 , we r and omly allocated 221 ( 50 % ) participants to BA and 219 ( 50 % ) to CBT . 175 ( 79 % ) participants were assessable for the primary outcome in the mITT population in the BA group compared with 189 ( 86 % ) in the CBT group , whereas 135 ( 61 % ) were assessable in the PP population in the BA group compared with 151 ( 69 % ) in the CBT group . BA was non-inferior to CBT ( mITT : CBT 8·4 PHQ-9 points [ SD 7·5 ] , BA 8·4 PHQ-9 points [ 7·0 ] , mean difference 0·1 PHQ-9 points [ 95 % CI −1·3 to 1·5 ] , p=0·89 ; PP : CBT 7·9 PHQ-9 points [ 7·3 ] ; BA 7·8 [ 6·5 ] , mean difference 0·0 PHQ-9 points [ –1·5 to 1·6 ] , p=0·99 ) . Two ( 1 % ) non-trial-related deaths ( one [ 1 % ] multidrug toxicity in the BA group and one [ 1 % ] cancer in the CBT group ) and 15 depression-related , but not treatment-related , serious adverse events ( three in the BA group and 12 in the CBT group ) occurred in three [ 2 % ] participants in the BA group ( two [ 1 % ] patients who overdosed and one [ 1 % ] who self-harmed ) and eight ( 4 % ) participants in the CBT group ( seven [ 4 % ] who overdosed and one [ 1 % ] who self-harmed ) . Interpretation We found that BA , a simpler psychological treatment than CBT , can be delivered by junior mental health workers with less intensive and costly training , with no lesser effect than CBT .  Effective psychological therapy for depression can be delivered without the need for costly and highly trained professionals . Funding National Institute for Health Research The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy ( GACT ) in patients with fibromyalgia ( FM ) compared with patients receiving recommended pharmacological treatment ( RPT ) or on a waiting list ( WL ) . The data were derived from a previously published study , a r and omized controlled trial that focused on clinical outcomes . Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory , respectively . Analyses included quality -adjusted life years , direct and indirect cost differences , and incremental cost effectiveness ratios . A total of 156 FM patients were r and omized ( 51 GACT , 52 RPT , 53 WL ) . GACT was related to significantly less direct costs over the 6-month study period compared with both control arms ( GACT € 824.2 ± 1,062.7 vs RPT € 1,730.7 ± 1,656.8 vs WL € 2,462.7 ± 2,822.0 ) . Lower direct costs  for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications . The incremental cost effectiveness ratios were dominant in the completers ' analysis and remained robust in the sensitivity analyses . In conclusion , acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM . PERSPECTIVE Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group . From government as well as health care perspectives , this study shows that a GACT  is more cost effective than pharmacological treatment in management of FM Objective To explore participant views on acceptability , mechanisms of change and impact of behavioural activation ( BA ) delivered by junior mental health workers ( MHWs ) versus cognitive behavioural therapy ( CBT ) delivered by professional psychotherapists . Design Semistructured qualitative interviews analysed using a framework approach . Participants 36 participants with major depressive disorder purposively sample d from a r and omised controlled trial of BA versus CBT ( the COBRA trial ) . Setting Primary care psychological therapies services in Devon , Durham and Leeds , UK . Results Elements of therapy considered to be beneficial included its length and regularity , the opportunity to learn and not dwelling on the past . Homework was an important , although challenging aspect of treatment . Therapists were perceived as experts who played an important role in treatment . For some participants the most important element of therapy was having someone to talk to , but for others the specific factors associated with BA and CBT were crucial , with behavioural change considered important for participants in both treatments , and cognitive change unsurprisingly discussed more by those receiving CBT . Both therapies were considered to have a positive impact on symptoms of depression and other areas of life including feelings about themselves , self-care , work and relationships . Barriers to therapy included work , family life and emotional challenges . A subset ( n=2 ) of BA participants commented that therapy felt too simple , and MHWs could be perceived as inexperienced . Many participants saw therapy as a learning experience , providing them with tools to take away , with work on relapse prevention essential . Conclusions Despite barriers for some participants , BA and CBT were perceived to have many benefits , to have brought about cognitive and behavioural change and to produce improvements in many domains of participants ’ lives . To optimise the delivery of BA , inexperienced junior MHWs should be supported through good quality training and ongoing supervision . Trial registration number IS RCT N27473954 , Background : A primary goal of dialectical behaviour therapy ( DBT ) is to reduce self-harm , but findings from empirical studies are inconclusive . The aim of this study was to assess the effectiveness and cost-effectiveness of  DBT  in reducing self-harm in patients with personality disorder . Methods : Participants with a personality disorder and at least 5 days of self-harm in the previous year were r and omised to receive 12 months of either  DBT or treatment as usual ( TAU ) . The primary outcome was the frequency of days with self-harm ; secondary outcomes included borderline personality disorder symptoms , general psychiatric symptoms , subjective quality of life , and costs of care . Results : Forty patients each were r and omised to DBT and TAU .  In an intention-to-treat analysis , there was a statistically significant treatment by time interaction for self-harm ( incidence rate ratio 0.91 , 95 % CI 0.89–0.92 , p < 0.001 ) . For every 2 months spent in DBT , the risk of self-harm decreased by 9 % relative to TAU . There was no evidence of differences on any secondary outcomes . The economic analysis revealed a total cost of a mean of 5,685 GBP ( 6,786 EUR ) in DBT compared to a mean of 3,754 GBP ( 4,481 EUR ) in TAU , but the difference was not significant ( 95 % CI –603 to 4,599 GBP ) . Forty-eight per cent of patients completed  DBT . They had a greater reduction in self-harm compared to dropouts ( incidence rate ratio 0.78 , 95 % CI 0.76–0.80 , p < 0.001 ) . Conclusions : DBT can be effective in reducing self-harm in patients with personality disorder , possibly incurring higher total treatment costs . The effect is stronger in those who complete treatment . Future research should explore how to improve treatment adherence A general approach is discussed to assess the uncertainty surrounding the  cost effectiveness ratio ( C/E-ratio )  estimated on the basis of data from a r and omised clinical trial . The approach includes the calculation of a 95 % probability ellipse and introduces the concept of a so called C/E-acceptability curve . This last curve defines for each predefined C/E-ratio the probability that the C/E-ratio found in the study is acceptable . The approach is illustrated by estimates of costs per life saved and costs per patient discharged alive on the basis of data from a phase II trial addressing the value of  anakinra  in treating sepsis syndrome Ost ( 2008 ) recently compared the method ological rigor of studies of  acceptance and commitment therapy ( ACT )  and traditional cognitive behavior therapy ( CBT ) . He concluded that the ACT studies had more method ological deficiencies , and thus the treatment did not qualify as an " empirically supported treatment . " Although Ost noted several important limitations that should be carefully considered when evaluating early  ACT research , his attempt to devise an empirical matching strategy by creating a comparison sample of CBT studies to bolster his conclusions was itself problematic . The sample s were clearly mismatched in terms of the population s being treated , leading to differences in study design and methodology . Furthermore , re analysis showed clear differences in grant support favoring CBT compared with ACT studies that were not reported in the original article . Given the actual mismatch between the sample s , Ost 's method ological ratings are difficult to interpret and provide little useful information beyond what could already be gathered by a qualitative review of ACT study limitations . Such limitations are characteristic of the earlier r and omized controlled trials of any emerging psychotherapeutic approach Background : Mindfulness-based interventions have been shown to effectively reduce anxiety , depression and pain in patients with chronic physical illnesses . Objectives : We assessed the potential effectiveness and cost-effectiveness of a specially adapted Skype distant-delivered mindfulness intervention , design ed to reduce distress for people affected by primary and secondary progressive MS . Methods Forty participants were r and omly assigned to the eight-week intervention ( n = 19 ) or a waiting-list control group ( n = 21 ) . Participants completed st and ardised question naires to measure mood , impact of MS and symptom severity , quality of life and service costs at baseline , post-intervention and three-month follow-up 
    Output:
    
Mindfulness-Based Cognitive Therapy ( MBCT ) , Mindfulness-Based Stress Reduction ( MBSR ) , Acceptance and Commitment Therapy ( ACT ) , Dialectical Behavior Therapy ( DBT ) , and extended Behaviour Activation ( eBA ) showed acceptable cost-effectiveness and cost-utility ratios .
There is some evidence that MBCT , MBSR , ACT , DBT , and eBA are efficient from a societal or a third-party payer perspective .
No economic analysis was found for many third-wave therapies .