Page 78 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
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  78 Chapter 4
 Abstract
Objective: For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This study examined differential (cost-) effectiveness for inpatient and outpatient anorexia nervosa patients before and after implement- ing cognitive behavioral therapy-enhanced (CBT-E) throughout a Dutch treatment center.
Methods: Differences in treatment costs, weight regain and improvement of eating disorder pathology were examined between two consecutive cohorts of adult patients, with one cohort (N = 75, between 2012-2014) receiving regular treat- ment-as-usual (TAU), and the other (N = 88 between 2015-2017) receiving CBT-E.
Results: In both cohorts, eating disorder attitudes improved. On clinical outcome no differences between the two cohorts were found, except on weight gain which was better in the CBT-E cohort (estimated mean difference = 1.39 kg/m2, SD = .28; 95% CI 0.82 - 1.9; p < .001). Limiting the cost-analysis to direct treatment costs, the cost-ef- fectiveness plane of the base case scenario for all patients indicates a 97% likelihood of CBT-E being superior to TAU at higher costs. The cost-effectiveness acceptability curve indicates that, assuming a willingness-to-pay of € 9713,- or more for an extra remission, CBT-E is more likely to be cost-effective, compared to treatment-as-usual.
Discussion: Findings suggest that in this real-world study, CBT-E is both effective and cost-effective on weight regain in adult anorexia nervosa patients, compared to treatment-as-usual, a regular, multimethod treatment. These findings may contrib- ute to implementation of specialized psychological treatments for anorexia nervosa in real world settings.
Introduction
Anorexia nervosa is a psychiatric disorder associated with a poor prognosis. For adults with anorexia nervosa, evidence is lacking for prioritizing one specialized treatment over the other, or even for prioritizing specialized over non-specialized treatments (Zeeck et al., 2018; Van den Berg et al., 2019). Furthermore, with regard to regaining weight or with regard to reducing anorexia nervosa psychopathology, no conclusive recommendations can be made on an optimum treatment setting (Madden, Hay & Touyz, 2015; Hay et al., 2019), even though guidelines agree on hospi- tal admission in case of high medical or psychiatric risk (Hay et al., 2019). Individ- ual eating-disorder-focused cognitive behavioural therapy is one of the specialized psychological treatments for adults recommended by NICE (NICE, 2017). For under-



























































































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