Economic evaluation of resilience training for medical students: A cohort state-transition model

Background: Resilience training shows moderate effect in combatting burnout, yet little is known about its cost-effectiveness. This study analyzes the cost-effectiveness of offering resilience training to medical students with elevated stress from a Dutch university medical center (payer) perspective compared to mental health support as usual. Methods: We constructed a state-transition cohort (Markov) model to estimate quality-adjusted lifeyears and associated costs of offering resilience training to a cohort of 410 first-year medical students over a 6-year timeframe. Utility values were obtained through baseline data from the DEcrease STress through RESilience training for Students (DESTRESS) study. Data on transition probabilities and the effect of resilience training were based on the best available literature. We resampled all data to generate 10,000 simulations of incremental costs and effects in a probabilistic analysis. Results: On average students gained 0.15 QALYs (95%CI 0.09, 0.20) at a cost-saving of €1076 (95%CI 412, 2008), making resilience training the dominant strategy. These savings resulted from an assumed reduction in study delay due to a reduction in symptoms of stress and burnout. For every euro the university invests in resilience training, we estimatea return of investment of €2.79. Conclusions: This study provides evidence that offering resilience training to medical students is cost-effective and cost-saving.