Page 157 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

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(Thompson-Brenner et al., 2018; Kazdin, Fitzsimmons-Craft, & Wifley, 2017; Waller & Turner, 2016). As outpatient CBT-E treatment has a fixed, relatively short duration, and as the duration of the CBT-E based inpatient stay is limited by nature, we assumed a reduction in direct treatment costs in both the CBT-E normal weight and the underweight cohorts, so assumed CBT-E to be superior from cost-effectiveness perspective.
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 clinical 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 treat- ment-as-usual and leading to more remissions at lower treatment costs. This compar- ative superiority of CBT-E from a cost-effectiveness perspective, was found for both outpatients and for inpatients. The improved cost-effectiveness is understandable in the light of the found shorter treatment duration and a shorter inpatient stay in the CBT-E cohort. For patients with an eating disorder and a body mass index over 17.5, the hypothesis of CBT-E being more effective than treatment-as-usual was not met, while the hypothesis that CBT-E is more cost-effective was met.
For anorexia nervosa patients, the findings suggested that weight regain was significantly better in the CBT-E cohort. With that exception on weight gain, no other differences in clinical outcome between both cohorts were found; in both cohorts, anorexia nervosa attitudes improved. When limiting the cost-analysis to direct treat- ment costs, and employing ‘achieving healthy weight’ as effect measure, the ICER distribution 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 employing ‘eating disorder remission’ as effect measure, differences between both cohorts were minimal.
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 probably relate to these found higher treatment costs; (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.