Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive–behavioural therapy in out-patients with anorexia nervosa

Abstract

Background. Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN.Method. The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses.Results. Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was 595% if the WTP per recovery was 5€9825 and 5€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends.Conclusions. Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.

Implementing cognitive behavioral therapy‐enhanced in a routine inpatient and outpatient setting: Comparing effectiveness and treatment costs in two consecutive cohorts

“…The finding that CBT-E for adult patients with all types of eating disorders and a BMI >17.5 is superior to TAU from a costeffectiveness perspective is, to our knowledge, 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.…”

The economic case for digital interventions for eating disorders among United States college students

“…Estimates for the sum cost of GSH intervention ($1,365.80) and prevention intervention ($505.86) were applied from the previous calculations. For individuals with anorexia nervosa, we used the cost from Egger and colleagues of $4,109.56 (converted to 2016 US dollars from €2,494) for delivering in‐person enhanced cognitive behavioral therapy (Egger et al, ).…”

“…Country or healthcare system practice guidelines may also impact the types of care utilized for treating anorexia nervosa; for example, in Germany, inpatient treatment is recommended initially as treatment for anorexia nervosa (Herpertz et al, ). Indeed, our model is limited in that we do not estimate the costs associated with higher levels of care for anorexia nervosa or other EDs (e.g., hospitalization, which bears high costs), medical expenditures that can result from EDs, or indirect costs associated with lost productivity, all of which increase total costs (Egger et al, ; Stuhldreher et al, ), meaning our calculation is an underestimate. We also do not account for the cost savings of avoiding excess medical utilization through prevention and early intervention associated with the stepped care model.…”

The modeled cost‐effectiveness of family‐based and adolescent‐focused treatment for anorexia nervosa

“…Byford et al () used the Morgan‐Russell Average Outcome Scale score as a primary outcome and found that specialized outpatient treatment for adolescents with AN (not limited to <3 years duration) including individual cognitive behavioural therapy (CBT) and parental counselling was more effective and less costly than inpatient treatment and TAU. Similarly, Egger et al () showed that outpatient psychotherapies for adults with AN, including focal psychodynamic therapy and enhanced CBT, were found to be less costly than optimized TAU in all outcomes examined (i.e., recovery, quality‐adjusted life years, BMI) from a societal economic perspective. It is noteworthy that both of these studies were economic evaluations conducted alongside clinical trials and that while the results supported the cost‐effectiveness of the active interventions, the differences between groups on both costs and outcomes were not statistically significant.…”