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.
    Full-text · Article · Dec 2015
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    • "). The economic consequences of eating disorders are also substantial, with high treatment costs and lost work productivity and wages (Lynch et al., 2010;Mond &amp; Hay, 2007;Samnaliev, Noh, Sonneville, &amp; Austin, 2015;Stuhldreher et al., 2012). Given the profound impact the disorders can have on all systems of the body and myriad domains of social and economic life, the work of prevention scientists is vital for the field and for population health. "
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    ABSTRACT: The public health burden of eating disorders is well documented, and over the past several decades, researchers have made important advances in the prevention of eating disorders and related problems with body image. Despite these advances, however, several critical limitations to the approaches developed to date leave the field far from achieving the large-scale impact that is needed. This commentary provides a brief review of what achievements in prevention have been made and identifies the gaps that limit the potential for greater impact on population health. A plan is then offered with specific action steps to accelerate progress in high-impact prevention, most compellingly by promoting a shift in priorities to policy translation research and training for scholars through the adoption of a triggers-to-action framework. Finally, the commentary provides an example of the application of the triggers-to-action framework as practiced at the Strategic Training Initiative for the Prevention of Eating Disorders, a program based at the Harvard T. H. Chan School of Public Health and Boston Children's Hospital. Much has been achieved in the nearly 30 years of research carried out for the prevention of eating disorders and body image problems, but several critical limitations undermine the field's potential for meaningful impact. Through a shift in the field's priorities to policy translation research and training with an emphasis on macro-environmental influences, the pace of progress in prevention can be accelerated and the potential for large-scale impact substantially improved.
    Preview · Article · Apr 2015 · Eating disorders
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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.
    Full-text · Article · May 2014 · Trials
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