Page 93 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 4 93
as-usual (TAU) between 2012-2014, the next receiving CBT-E between 2015-2017. Both cohorts were seriously affected, with around 24% of patients having a BMI under 15, and around 40% of patients having an illness duration of seven years or longer.
There are two main findings. The first finding is that weight regain was better in the CBT-E cohort. Other than on weight regain, no relevant differences in clin- ical outcomes were found. In both cohorts, anorexia nervosa attitudes improved significantly, which is important because weight regain is usually accompanied by an increase in eating, shape and weight concerns, so challenging maintaining the weight regained. In both cohorts, no significant decrease on bingeing, vomiting and laxatives misuse was found. With regard to those behaviors it is worth noting that the use of the self-report EDE-Q may have overestimated the reporting of binges in this study (Fairburn & Beglin, 1994).
The second main finding was that when limiting the cost-analysis to direct treat- ment costs, employing 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 assum- ing a WTP of € 9713,- or more for each additional remission. This WTP of € 9713,- is lower than some reported costs-of-illness for anorexia nervosa (Stuhldreher et al. 2015). Differences between TAU and CBT-E were minimal, when eating disorder remission was employed as effect measure. Examining outpatients only, the supe- riority of CBT-E over TAU is even stronger, on reaching healthy weight, but also on eating disorder remission.
The hypothesis of CBT-E being more effective was confirmed with regard to weight gain and economic evaluation showed that CBT-E was superior to TAU on weight gain, although at higher costs.
The present finding suggesting that, within a routine setting, CBT-E for adult patients with anorexia nervosa leads to better weight regain compared to TAU is, to our knowledge, new.
Several factors may have contributed to the better weight gain during CBT-E; as weight regain is usually better within an inpatient setting compared to an outpatient setting (Waller, 2016), the higher admission rate, although shorter, during CBT-E may have contributed. In addition, literature suggests that studies with reported training have a larger effect on weight regain compared to studies without reported training (Van den Berg et al., 2019), so perhaps the structured training during CBT-E may have contributed as well, next to the probable potency of CBT-E.
Comparing our findings in the CBT-E cohort with other CBT-E anorexia effective- ness studies is somewhat limited because some studies excluded patients with