Page 138 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

138 Chapter 7
Part II
Status of Cognitive behavioral therapy-Enhanced
When developing psychological treatments, it is important to establish their effi- cacy in a controlled setting. Of equal importance are effectiveness studies in which the benefits and applicability of treatments are examined in a non-controlled, real-world setting, where the vast majority of patients receives treatment and where treatment
interventions are offered by a wide range of staff members. Besides clinical outcome, in effectiveness studies, it is important to examine the feasibility of the developed treatment, focusing on recruitment, acceptability, attrition, accessibility and on treatment costs (Wade, 2020).
In Part II, we examine whether changing from offering eclectic treatment-as-usual to offering CBT-E, an individually based cognitive behavior therapy for eating disorders as recommended for bulimia nervosa, binge eating disorder and for anorexia nervosa (National Institute for Health and Care Excellence, 2017) improves clinical outcome and enhance cost-effectiveness, as it is assumed that outcome may be enhanced by replacing an eclectic approach with an empirically supported treatment (Thompson-Brenner et al., 2018; Kazdin, Fitzsimmons-Craft, & Wifley, 2017; Waller & Turner, 2016). In two consecutive cohort studies, we examined possible benefits of offering CBT-E to eating disorder patients with a body mass index over 17.5 kg/m2 (i.e. patients with bulimia nervosa, a binge eating disorder or other specified feeding or eating disorder) and separately for patients with anorexia nervosa.
Main findings
For patients with bulimia, binge eating disorder or other specified feeding or eating disorder and a body mass index over 17.5, no significant differences on clin- ical outcome were found between treatment-as-usual and CBT-E. In both cohorts, eating disorder pathology decreased significantly. With regard to cost-effectiveness, findings indicated a 71% likelihood of CBT-E dominating treatment-as-usual, and leading to more remissions at lower treatment costs. There is a 29% likelihood of CBT-E leading to fewer remissions at lower costs. The likelihood of treatment-as- usual leading to lower treatment costs is 0%. This comparative superiority of CBT-E from a cost-effectiveness perspective, was found for both outpatients and for inpa- tients. The improved cost-effectiveness is understandable in the light of a shorter treatment duration and a shorter inpatient stay during the CBT-E period.
The hypothesis of CBT-E being more effective than treatment-as-usual was not met for patients with an eating disorder and a body mass index over 17.5, but the hypothesis of CBT-E being more cost-effective was.