To identify, critically appraise, and synthesize evidence on the cost-effectiveness of MTCI.
We searched Medline, Embase, CINAHL, and CENTRAL for randomized controlled trials reporting cost-effectiveness outcomes, including healthcare or societal costs and quality of life or quality-adjusted life years (QALY) from inception to July 2024. We harmonized cost data with consumer price indices and purchasing power parities. Evidence certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. Incremental costs and effects were pooled separately, and the primary outcome was the incremental net monetary benefits (INMB). We performed Monte Carlo simulations to estimate covariances between incremental costs and effects and calculated INMBs for each study. We stratified results by economic perspective and follow-up duration. A novel aspect of our approach was the calculation of INMB across a range of willingness to pay (WTP) thresholds, from €0 to €100,000 in €5,000 increments. Cost-effectiveness acceptability curves were generated to illustrate the probability of cost-effectiveness at each WTP threshold, providing robust guidance for healthcare decision-making.
Thirteen trials, containing 4,114 patients, were included. Over 12 months, there was “low” certainty that MTCI reduced healthcare costs (MD, €-3452; 95% CI, -8816 to 1912), while maintaining QALY-levels (MD, 0.00; 95% CI, -0.03 to 0.04) compared to usual care. The probability of cost-effectiveness was 90% at a WTP of €0/QALY, decreasing slightly to 84% with higher WTPs (“moderate” certainty). Over six months, cost-effectiveness probabilities ranged from 43% at €0/QALY to 87%, exceeding 80% at a WTP of €50,000/QALY (“low” to “moderate” certainty).
Our findings suggest that MTCI may reduce healthcare costs while maintaining or increasing QALY levels, and therefore be cost-effective.
This cost-effectiveness meta-analysis of MTCI provides valuable insights to inform healthcare decision-making globally. MTCI show a high probability of cost-effectiveness compared to usual care, even at a WTP threshold of €0 per QALY gained. However, the significant heterogeneity observed highlights the need for future research to explore variations in effects on costs and QALY across different intervention types and/or complexity, patient populations, and country income levels to identify the most cost-effective strategies. We recommend updating this meta-analysis as more data become available in the coming years to refine these findings further.
Cost-effectiveness
Quality of Life
