Page 72 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

72 Chapter 3
of their prior education, so long as they are well-trained in CBT-E and have a keen interest in treating eating disorders. This principle seems to be effective, as outcome did not change after CBT-E implementation.
During the CBT-E period, therapist fidelity was not assessed systematically. Therefore, to monitor and enhance CBT-E adherence, during intervision, audiotaped sessions were reviewed. In the study design, a 6-month ‘transition period’ was put in between the lead time of both cohorts to prevent contamination of the TAU period with newly-learned CBT-E interventions and at the same time, allowing staff to be familiarized with CBT-E. However, contamination cannot be completely ruled out. With regard to costs, additional societal and potential concurrent health costs were not measured and valuated. Besides, the used standardized costs may differ from actual costs accrued or paid by third-party payers.
Implications
The finding that, when limiting cost analysis to direct treatment costs, an EST, including intensive intervision, is more cost effective than TAU may be important for decision makers and may help speed up implementation of ESTs. CBT-E is a time limited, outpatient treatment; therefore, implementing CBT-E will lead to a shorter inpatient stay and treatment duration, which is beneficial for patients and leads to better value health care (Porter, 2010).
An altered treatment staff is likely to enhance cost-effectiveness, although not analysed in this study. Implementing CBT-E and as consequence, terminating all incompatible interventions has impact on staff, especially when they are less CBT-orientated and no longer able to use interventions they used before.
Conclusions
The findings suggest that CBT-Enhanced is potentially cost-effective compared to TAU, when the cost analysis is limited to direct treatment costs. Based on the dataset used, it cannot be claimed that on clinical outcomes, CBT-E is more effective. This study shows that implementing an EST throughout outpatient as well as inpatient settings, is feasible, leads to lower treatment costs with similar treatment effect and has the advantage of shorter treatment duration and a shorter inpatient stay.