Page 71 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 3 71
new. It is in contrast with the outpatient anorexia nervosa study of Egger, Wild and Zipfel (2016) which found the probability of CBT-E being cost-effective compared to TAU was < 90% for all WTPs.
Strengths
The main strength of this study is that the examined treatments were not offered within the limiting context of a selective clinical trial, so findings are likely to gener- alize to other routine centers. Besides, for the cost-effectiveness analyses, instead of model costs, actual costs were used. As ample effort was undertaken to imple- ment CBT-E model truly, throughout all multidisciplinary teams and parallel to implementing new interventions, terminating all CBT-E incompatible interventions, outpatients who needed hospitalization were offered continuous and similar inter- ventions despite the different treatment setting.
With regard to clinical outcome, beside remission rates, results on reliable and clinical significant change were reported. This study also contributes to enhancing transparency by making clinical outcome gathered over several years and numerous patients, public. Studying and learning from the variation in service outcomes can help develop more effective health care (Clark et al., 2018).
Limitations
While, as is common in routine settings, a considerable amount of data are missing, analyses showed that patients with and without complete data did not differ and missing data were handled adequately. As there are no follow up data, longer term effects could not be taken into account.
Due to the design of comparing two consecutive cohorts over a 5-year period, potential confounding variables might have occurred, due to the lapse of time. Although a considerable time frame, it is in line with other effectiveness studies; Byrne study captured a 4-year period (Byrne et al., 2011) and the Turner study 3 years (Turner et al., 2015). As baseline analyses showed that key characteristics did not differ between both cohorts, the patient population can be assumed not to have changed over time. The difference with regard to the eating disorder diagnoses distri- bution is linked to slightly changed DSM-5 criteria. Program leadership, senior staff and the financing system did not change during the time frame of this study. In 2015- 2017, however, staff grew, while other than during TAU, treatment was delivered not only by academic staff but also by psychiatric nurses and dieticians. One of the prin- ciples underlying CBT-E is that treatment can be delivered by therapists irrespective