{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:21:16Z","timestamp":1793380876263,"version":"4.5.0"},"reference-count":57,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2024,12,18]],"date-time":"2024-12-18T00:00:00Z","timestamp":1734480000000},"content-version":"unspecified","delay-in-days":17,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"crossref","award":["Programme Grants for Applied Research (PGfAR) Prog"],"award-info":[{"award-number":["Programme Grants for Applied Research (PGfAR) Prog"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,11,18]]},"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicentre, single-blind, randomised controlled trial (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"74643496\">ISRCTN74643496<\/jats:ext-link>\n                      ) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the primary cost-effectiveness analysis, MCT intervention was dominant, with a cost-saving (net cost \u2212\u00a3219; 95%\u2009CI \u2212\u00a31446, \u00a31007) and QALY gains (net QALY 0.015; 95%\u2009CI \u22120.015, 0.045). However, there is a high level of uncertainty in the estimates. At a threshold of \u00a330\u2009000 per QALY, MCT intervention of around 76% was likely to be cost-effective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Results 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-087414","type":"journal-article","created":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T15:35:50Z","timestamp":1734968150000},"page":"e087414","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Cost-effectiveness of metacognitive therapy for cardiac rehabilitation participants with symptoms of anxiety and\/or depression: analysis of a randomised controlled trial"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"isrctn74643496","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4869-7524","authenticated-orcid":false,"given":"Gemma E","family":"Shields","sequence":"first","affiliation":[{"name":"Manchester Centre for Health Economics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9574-7710","authenticated-orcid":false,"given":"Elizabeth","family":"Camacho","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M","family":"Davies","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1887-0237","authenticated-orcid":false,"given":"Patrick Joseph","family":"Doherty","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6377-6859","authenticated-orcid":false,"given":"David","family":"Reeves","sequence":"additional","affiliation":[{"name":"Centre for Primary Care, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora","family":"Capobianco","sequence":"additional","affiliation":[{"name":"Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK"},{"name":"Division of Psychology & Mental Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Heagerty","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Sciences, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Heal","sequence":"additional","affiliation":[{"name":"Centre for Biostatistics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2271-6400","authenticated-orcid":false,"given":"Deborah","family":"Buck","sequence":"additional","affiliation":[{"name":"Manchester Centre for Health Economics, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Wells","sequence":"additional","affiliation":[{"name":"Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK"},{"name":"Division of Psychology & Mental Health, University of Manchester, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"2025121220010272000_14.12.e087414.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"2025121220010272000_14.12.e087414.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab892"},{"key":"2025121220010272000_14.12.e087414.3","unstructured":"Cardiovascular disease in England | the king\u2019s fund. 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