Page 58 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

58 Chapter 3
consisted of heterogeneous, eclectic psychological interventions, psychoeducation and dietary advice. This study is the first CBT-E (cost) effectiveness study including all referred inpatients and outpatients, treated by all staff members in a routine treatment center, during a two-and-a-half year period. We hypothesized that imple- menting CBT-E would lead to an improvement in effectiveness and cost-effectiveness compared to TAU.
Method
The design and reporting follows the Strengthening the Reporting of Observa- tional Studies in Epidemiology (STROBE) statement (Vandenbroucke et al., 2007) and the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) state- ment (Husereau et al., 2013). Dutch Commission on Human Research (CCMO) has ruled that no ethical approval is needed for research with anonymized data obtained in routine practice: all patients gave consent for data to be collected as part of routine service evaluation.
Design and participants
Treatment costs and clinical outcome on eating disorder and general patholo- gy were compared between two samples: the first sample consisted of all referred patients, BMI between 17.5 and 40, receiving TAU between July 1, 2012 and Decem- ber 31, 2014 (N = 785). After implementing CBT-E throughout the out- and inpatient units in 2015, the second sample consisted of all referred patients receiving CBT-E between July 1, 2015 and December 31, 2017 (N = 900). In both cohorts, inpatient and outpatient treatment were offered.
Patients were referred by general practitioners, secondary healthcare profession- als or general hospitals to a Dutch routine eating disorder center which treats patients over 18, voluntarily. All patients met DSM-IV (American Psychiatric Association, 1994) or DSM-5 (American Psychiatric Association, 2013) eating disorder criteria, as assessed by a clinical psychologist or psychiatrist. Patients with under three contacts were excluded; as assessment takes up to three contacts, it is assumed that those patients have not started psychological treatment. Due to differences in, somatically related, treatment costs, analyses of patients with BMI < 17.5 will be presented sepa- rately. Figure 1 shows the recruitment and retention figures for both cohorts.