Page 79 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg
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  Chapter 4 79
 weight patients, Fairburn et al. (Fairburn, 2008) developed an enhanced eating-disor- der-focused individual cognitive behavior therapy (CBT-E Underweight), an adaption of CBT-E for normal weight eating disorder patients. Effectiveness studies showed that CBT-E Underweight can be delivered in both routine outpatient practice (Byrne et al., 2011; Fairburn et al., 2013; Turner et al, 2015; Signorini et al., 2017; Frostad et al., 2018) and inpatient practice (Dalle Grave et al., 2013). Despite these findings, imple- mentation of recommended specialized treatments in routine practice lag, especial- ly in inpatient settings (Thompson-Brenner et al., 2018).
Published CBT-E Underweight effectiveness studies involved a limited number of therapists and, in most outpatient studies, patients with severe underweight were excluded (Byrne et al., 2011; Signorini et al., 2017; Frostad et al., 2018). Besides, as the involved outpatient services were unable to offer inpatient care, in case of hospitali- zation, CBT-E interventions were discontinued.
Examining cost-effectiveness of recommended treatments next to effectiveness, is valuable and may contribute to decision making on what treatment best to offer in clinical practice, but for anorexia nervosa, they are rarely done (Crow et al., 2013). An economic evaluation on adolescents with anorexia nervosa suggests that specialist outpatient services have a higher probability of being cost-effective than both general services and inpatient services (Byford et al., 2007). Until now, there has been only one economic evaluation of CBT-E Underweight; Egger et al., examined the cost- effectiveness of focal psychodynamic psychotherapy, treatment-as-usual (TAU) and CBT-E for outpatients. They found that, employing weight gain as effect measure, CBT-E Underweight was dominant compared with TAU, although differences in weight regain between the conditions were negligible (Egger et al., 2016).
The aims of the present study were to examine (1) effectiveness and (2) cost- effectiveness of CBT-E Underweight, offered to all referred adult anorexia nervosa inpatients and outpatients (N = 88) receiving treatment between 2015 and 2017, compared with treatment-as-usual offered to all referred patients (N = 75) between 2012-2014. We hypothesized that, compared to treatment-as-usual, implementing CBT-E Underweight would lead to an improvement in effectiveness and in cost- effectiveness.
This is the first CBT-E (cost)-effectiveness study including all referred inpatients and outpatients with a BMI between 12.5 and 17.5, during a two-and-a-half year period.





























































































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