Page 56 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

56 Chapter 3
Abstract
Background: Even though evidence-based interventions can enhance clinical outcomes and cost-effectiveness, in the field of eating disorders, implementation of empirically-supported treatments (ESTs) in routine inpatient and outpatient settings is slow.
Objective: This study examined differential (cost-) effectiveness, after imple- menting evidence-based Cognitive Behavioral Therapy-Enhanced (CBT-E) through- out a Dutch treatment center.
Method: Two consecutive cohorts of adult patients, BMI between 17.5 and 40, were compared, with one cohort (N = 239) receiving treatment-as-usual (TAU) between 2012-2014, the other (N = 320) receiving CBT-E between 2015-2017.
Results: Eating disorder pathology, measured with self-reports, decreased signif- icantly in both cohorts; overall, no differences in clinical outcomes between both cohorts were found. Treatment costs and treatment duration were considerably lower in 2015-2017. When limiting the cost analysis to direct costs, there is a 71% likelihood that CBT-E is more cost effective and a 29% likelihood that CBT-E leads to fewer remissions at lower costs, based on the distribution of the cost-effectiveness plane. The likelihood that TAU leads to lower costs is 0%.
Discussion: Findings show that implementing an empirically-supported treat- ment throughout inpatient and outpatient settings, leads to lower costs with similar treatment effect, and has the advantage of shorter treatment duration and a shorter inpatient stay.
Introduction
Although it has been established that empirically-supported treatments (ESTs) can be successfully implemented in non-academic, routine practice, in the field of eating disorders, the dissemination and implementation of ESTs are slow (Kazdin, Fitzsimmons-Craft, & Wifley, 2017; Waller, 2016; Lilienfeld et al., 2013), with poten- tially suboptimal treatment delivery and treatment outcomes. Given the difficulty of implementing cohesive evidence-based practices in inpatient settings with multi- modal, multidisciplinary teams, implementation of ESTs in these settings is even slower (Thompson-Brenner et al., 2018). Most residential programs have maintained a heterogeneous therapeutic stance offering a range of eclectic, often not theoretical- ly cohesive, interventions (Guarda & Attia, 2018).