OBJECTIVES: Compare the costs and effectiveness of a nonpharmacologic intervention, mindfulness-based art therapy (MBAT) aimed at psychological stress reduction for women with breast cancer. METHODS: Participants were randomized into three groups: MBAT, Usual Breast Cancer Support (BCSG), or Untreated Control (UC). The MBAT intervention involved mindfulness-based stress reduction techniques along with art therapy. BCSG provided didactic lectures and discussion among participants. Each group attended programs for 8 weeks, for 2 ½ hours each week. Follow-up was done at 9 weeks. Healthcare costs due to psychological problems were captured in the form of healthcare utilization, including outpatient calls to physicians, outpatient visits, emergency room visits, and inpatient admissions, as well as cost of medications. Effectiveness was measured using health utility deduced from the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). RESULTS: The number of women in each group was: 98 completing MBAT, 93 completing BCSG, 44 UC. Mean healthcare costs due to psychological problems decreased at 9 weeks in the MBAT group (from $98.96/month to $0.00/month), increased in BCSG (from $3.60/month to $32.06/month), and stayed consistent with no healthcare utilization in UC. Medication costs decreased in all 3 groups at 9 weeks (MBAT: $50.23/month to $6.40/month; BCSG: $48.87/month to $13.69/month; UC: $46.80/month to $24.63/month). Health utility (mean,SD) increased at week 9 in all groups: MBAT from 0.47(.085) to 0.50(.076); BCSG from 0.50(.086) to 0.52(.084); UC from 0.52(.086) to 0.55(.058). CONCLUSIONS: All groups experienced similar utility improvements at 9 weeks, suggesting that the decision as to whether to choose MBAT, BCSG, or UC should be based on costs. However, these data are short-term and should be interpreted cautiously since sustained quality of life is important to the decision. Findings suggest that MBAT may reduce healthcare costs due to psychological problems but a larger sample is necessary to confirm this.