Page 139 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 7 139
For anorexia nervosa patients, findings suggested that weight regain was sig- nificantly better in the CBT-E cohort. With that exception on weight gain, no other differences in clinical outcome between both cohorts were found, anorexia nervosa attitudes improved in both cohorts. When limiting the cost-analysis to direct
treatment costs, and employing healthy weight as effect measure, the ICER distribu- tion for all patients indicates a 97% likelihood of CBT-E leading to better effects than TAU, at higher costs. The CEAC indicates a probability of CBT-E being cost-effective assuming a WTP of € 9713,- or more for each additional remission. When employ- ing eating disorder remission as effect measure, differences between both cohorts were minimal. Examining outpatients only, the superiority of CBT-E over TAU is even stronger, on reaching healthy weight, and also on eating disorder remission.
For patients with anorexia nervosa, the hypothesis of CBT-E being more effective was met on weight gain. Economic evaluation showed that CBT-E was superior to treatment-as-usual on weight gain, although at higher costs. Two factors can probably be linked to the found higher treatment costs during the CBT-E period; (1) compared to treatment-as-usual, more patients were admitted to the inpatient unit, although for a shorter period of time, and (2) fewer patients stopped treatment prematurely. Consequently, more patients received the recommended number of outpatient sessions.
Comparing clinical outcomes for normal weight patients in our (cost-)effective- ness study, with original Oxford studies by Fairburn and his team, the proportion of patients achieving remission seems in line (Fairburn et al., 2009; Fairburn et al., 2015). Comparing our findings of the anorexia nervosa (cost-) effectiveness study to both an Oxford-Italy outpatient anorexia nervosa study (Fairburn et al., 2013) and an inpa- tient Italian-Oxford study (Dalle Grave et al., 2013), findings also seem in line, on both the outcomes measures ‘weight regain’ and on ‘the proportion of patients achieving healthy weight’. As the clinical outcome of our presented studies is generally in line with outcome found in studies undertaken by the treatment developing team, both for anorexia nervosa patients and for bulimia or binge eating disorder patients, CBT-E might be assumed to be applicable in a real-world setting, where treatment is offered by multidisciplinary staff members. The comparative low dropout rate found in both (cost-) effectiveness studies contributes to the feasibility of CBT-E.
For bulimia and binge eating disorder, implementing CBT-E led to improved cost-effectiveness
The main benefit of implementing CBT-E for bulimia and binge eating disorder, is an improved cost-effectiveness. This superior cost-effectiveness is important