Cost-Effectiveness of Guided Self-Help Treatment for Recurrent Binge Eating

Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 06/2010; 78(3):322-33. DOI: 10.1037/a0018982
Source: PubMed


Adoption of effective treatments for recurrent binge-eating disorders depends on the balance of costs and benefits. Using data from a recent randomized controlled trial, we conducted an incremental cost-effectiveness analysis (CEA) of a cognitive-behavioral therapy guided self-help intervention (CBT-GSH) to treat recurrent binge eating compared to treatment as usual (TAU).
Participants were 123 adult members of an HMO (mean age = 37.2 years, 91.9% female, 96.7% non-Hispanic White) who met criteria for eating disorders involving binge eating as measured by the Eating Disorder Examination (C. G. Fairburn & Z. Cooper, 1993). Participants were randomized either to treatment as usual (TAU) or to TAU plus CBT-GSH. The clinical outcomes were binge-free days and quality-adjusted life years (QALYs); total societal cost was estimated using costs to patients and the health plan and related costs.
Compared to those receiving TAU only, those who received TAU plus CBT-GSH experienced 25.2 more binge-free days and had lower total societal costs of $427 over 12 months following the intervention (incremental CEA ratio of -$20.23 per binge-free day or -$26,847 per QALY). Lower costs in the TAU plus CBT-GSH group were due to reduced use of TAU services in that group, resulting in lower net costs for the TAU plus CBT group despite the additional cost of CBT-GSH.
Findings support CBT-GSH dissemination for recurrent binge-eating treatment.

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Available from: Frances Lynch, Jun 13, 2014
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    • "Recent studies have also begun to measure the non-health care impacts of ED, including work productivity and impairment (Lynch et al., 2010; Mond & Hay, 2007); however, specific estimates of lost productivity associated with ED are still lacking. In a recent review of 18 economic evaluations of ED (Stuhldreher, 2012), none evaluated lost productivity in the US. "
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    ABSTRACT: Background: Very little is known about the economic burden of eating disorders (ED) and related mental health comorbidities. Methods: Using 5. years of data from the U.S. Medical Expenditures Panel Survey, we estimated the difference in annual health care costs, employment status, and earned income (2011 US$) between individuals with current ED compared to those without ED. We further estimated the contribution of mental health comorbidities to these disparities in health care costs, employment and earnings. Results: Individuals with ED had greater annual health care costs ($1869, p. =. 0.012), lower but borderline significant employment rates (OR. =. 0.67, 95% CIs [0.41, 1.09]), and lower but not statistically significant earnings among those who were employed ($2093, p. =. 0.48), compared to individuals without ED. Among individuals with ED, the presence of mental health comorbidities was associated with higher but not statistically significant health care costs ($1993, p. =. 0.17), lower borderline significant odds of employment (OR. =. 0.41, 95% CIs [0.14, 1.20]), and significantly lower earnings ($19,374, p. <. 0.01). Conclusions: Treatment and prevention of ED may have broader economic benefits in terms of heath care savings and gains in work productivity than previously recognized. This exploratory study justifies large scale evaluations of the societal economic impact of eating disorders and comorbidities.
    12/2015; 2:32-34. DOI:10.1016/j.pmedr.2014.12.002
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    • "An estimate of cost effectiveness will be made by monitoring resource use directly associated with different treatment conditions (for example, therapist time spent providing care). The proportion of binge-free days (estimated through the EDE-Q) will also be used to estimate cost effectiveness (for example, [46]). Therapist time will be estimated using a simple checklist of time spent engaged in treatment-related activities. "
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    ABSTRACT: Background Guided self-help is a recommended first-step treatment for bulimia nervosa, binge eating disorder and atypical variants of these disorders. Further research is needed to compare guided self-help that is delivered face-to-face versus via email. Methods/Design This clinical trial uses a randomised, controlled design to investigate the effectiveness of providing guided self-help either face-to-face or via e-mail, also using a delayed treatment control condition. At least 17 individuals are required per group, giving a minimum N of 51. Discussion Symptom outcomes will be assessed and estimates of cost-effectiveness made. Results are proposed to be disseminated locally and internationally (through submission to conferences and peer-reviewed journals), and will hopefully inform local service provision. The trial has been approved by an ethics review board and was registered with NCT01832792 on 9 April 2013.
    Trials 05/2014; 15(1):181. DOI:10.1186/1745-6215-15-181 · 1.73 Impact Factor
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    • "6. Having used the latest internet technology, it would have been very desirable to also assess issues concerning cost effectiveness of RP as compared to TAU, similar to the work done by the group of Ruth Striegel-Moore on conventionally offered, guided self-help for binge eating [65,66]. However, time and budget restrictions did not allow for inclusion of this important issue. "
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    ABSTRACT: Background To study the longer term effects of an internet-based CBT intervention for relapse prevention (RP) in anorexia nervosa. Methods 210 women randomized to the RP intervention group (full and partial completers) or the control group were assessed for eating and general psychopathology. Multiple regression analysis identified predictors of favorable course concerning Body Mass Index (BMI). Logistic regression analysis identified predictors of adherence to the RP program. Results Most variables assessed showed more improvement for the RP than for the control group. However, only some scales reached statistical significance (bulimic behavior and menstrual function, assessed by expert interviewers blind to treatment condition). Very good results (BMI) were seen for the subgroup of “full completers” who participated in all nine monthly RP internet-based intervention sessions. “Partial completers” and controls (the latter non-significantly) underwent more weeks of inpatient treatment during the study period than “full completers”, indicating better health and less need for additional treatment among the “full completers”. Main long-term predictors for favorable course were adherence to RP, more spontaneity, and more ineffectiveness. Main predictors of good adherence to RP were remission from lifetime mood and lifetime anxiety disorder, a shorter duration of eating disorder, and additional inpatient treatment during RP. Conclusions Considering the high chronicity of AN, internet-based relapse prevention following intensive treatment appears to be promising.
    International Journal of Eating Disorders 07/2013; 1(1):23. DOI:10.1186/2050-2974-1-23 · 3.13 Impact Factor
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