Economic evaluation of cognitive behavioral therapy and Internet‐based guided self‐help for binge‐eating disorder

König, Hans‐Helmut; Bleibler, Florian; Friederich, Hans‐Christoph; Herpertz, Stephan; Lam, TH; Mayr, Andreas; Schmidt, Frauke; Svaldi, Jennifer; Zipfel, Stephan; Brettschneider, Christian; Hilbert, Anja; Zwaan, Martina de; Egger, Nina

doi:10.1002/eat.22822

Cited by 39 publications

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References 32 publications

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“…Several systematic reviews of economic evaluations on mental health-related digital interventions conducted in recent years identified 5 studies for anxiety disorder [ 37 ], 16 articles for mental health in general [ 38 ], and 12 studies for depression [ 39 ], respectively. Other economic evaluations of digital health interventions cover a wide range of target conditions, including irritable bowel syndrome [ 40 ], substance misuse [ 41 ], weight management [ 42 ], insomnia [ 43 , 44 ], eating disorders [ 45 , 46 ] and postoperative recovery [ 47 ]. Results of these studies were favourable regarding costs, especially when wider health care or societal costs were taken into account but did not show a significant impact on quality of life during follow-up periods.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial

Parrott

Sweeting

et al. 2018

J Med Internet Res

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BackgroundType 2 diabetes mellitus is one of the most common long-term conditions, and costs health services approximately 10% of their total budget. Active self-management by patients improves outcomes and reduces health service costs. While the existing evidence suggested that uptake of self-management education was low, the development of internet-based technology might improve the situation.ObjectiveTo establish the cost-effectiveness of a Web-based self-management program for people with type 2 diabetes (HeLP-Diabetes) compared to usual care.MethodsAn incremental cost-effectiveness analysis was conducted, from a National Health Service and personal and social services perspective, based on data collected from a multi-center, two-arm individually randomized controlled trial over 12 months. Adults aged 18 or over with a diagnosis of type 2 diabetes and registered with the 21 participating general practices (primary care) in England, UK, were approached. People who were unable to provide informed consent or to use the intervention, terminally ill, or currently participating in a trial of an alternative self-management intervention, were excluded. The participants were then randomized to either usual care plus HeLP-Diabetes, an interactive, theoretically-informed Web-based self-management program, or to usual care plus access to a comparator website containing basic information only. The participants’ intervention costs and wider health care resource use were collected as well as two health-related quality of life measures: the Problem Areas in Diabetes (PAID) Scale and EQ-5D-3L. EQ-5D-3L was then used to calculate quality-adjusted life years (QALYs). The primary analysis was based on intention-to-treat, using multiple imputation to handle the missing data.ResultsIn total, 374 participants were randomized, with 185 in the intervention group and 189 in the control group. The primary analysis showed incremental cost-effectiveness ratios of £58 (95% CI –411 to 587) per unit improvement on PAID scale and £5550 (95% CI –21,077 to 52,356) per QALY gained by HeLP-Diabetes, compared to the control. The complete case analysis showed less cost-effectiveness and higher uncertainty with incremental cost-effectiveness ratios of £116 (95% CI –1299 to 1690) per unit improvement on PAID scale and £18,500 (95% CI –203,949 to 190,267) per QALY. The cost-effectiveness acceptability curve showed an 87% probability of cost-effectiveness at £20,000 per QALY willingness-to-pay threshold. The one-way sensitivity analyses estimated 363 users would be needed to use the intervention for it to become less costly than usual care.ConclusionsFacilitated access to HeLP-Diabetes is cost-effective, compared to usual care, under the recommended threshold of £20,000 to £30,000 per QALY by National Institute of Health and Care Excellence.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 02123133; http://www.controlled-trials.com/ISRCTN02123133 (Archived by WebCite at http://www.webcitation.org/6zqjhmn00)

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Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial

Parrott

Sweeting

et al. 2018

J Med Internet Res

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“…130 However, internet based guided-self-help, while cheaper than in person CBT, has been shown to be less efficacious. 131 While CBT is not recommended as the primary treatment of T2DM itself, some evidence suggests that it may have a positive short-term effect on glycemic control, though results are inconclusive. 132 Both therapist-led and guided self-help versions of CBT are well-founded treatments for BED, with fairly strong evidence from metaanalyses and systematic reviews supporting their use.…”

Section: Cbtmentioning

confidence: 99%

<p>Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges</p>

Chevinsky¹,

Wadden²,

Chao³

2020

DMSO

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Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.

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“…Within the past few years, several studies examined Internet‐based guided self‐help (GSH‐I) for eating disorders because of its potential to improve reach and dissemination of evidence‐based face‐to‐face treatment (e.g., Aardoom, Dingemans, & van Furth, ; Bauer & Moessner, ; de Zwaan et al, ; Kazdin, Fitzsimmons‐Craft, & Wilfley, ; König et al, ; Melioli et al, ; Wagner et al, ). Benefits of GSH‐I include the relative anonymity of the Internet, its widespread and unlimited availability, and thus low threshold for patients to access and complete psychological interventions (Schlegl, Bürger, Schmidt, Herbst, & Voderholzer, ; ter Huurne et al, ).…”

Section: Introductionmentioning

confidence: 99%

Adherence as a predictor of dropout in Internet‐based guided self‐help for adults with binge‐eating disorder and overweight or obesity

Puls

Schmidt

Herpertz

et al. 2019

Intl J Eating Disorders

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Objective: Internet-based guided self-help (GSH-I) is an efficacious treatment for adults with binge-eating disorder (BED) and overweight or obesity. Although broadly accessible, high dropout from GSH-I has been reported. However, little is known about the factors explaining dropout from GSH-I, including patients' adherence to treatment.Method: Within a randomized trial on the treatment of BED, adherence to 4-month GSH-I was objectively assessed in N = 89 patients with BED and overweight or obesity. Objective adherence and subjective treatment evaluation were evaluated as predictors of dropout from GSH-I, defined as having accessed 5 or less of 11 modules.Cutoffs with optimal sensitivity and specificity were derived using Receiver Operating Characteristics curves analysis, and baseline sociodemographic and clinical correlates were determined.Results: According to our definition, n = 22 (24.7%) patients were defined as dropouts. Results of the full logistic regression model accounted for 72% of the variance in dropout and all objective adherence parameters (i.e., number of messages exchanged, days with a completed food diary, and days spent per module), but not patients' subjective GSH-I evaluation significantly predicted dropout. Specifically, not completing the food diary in week 7 had maximized sensitivity and specificity in predicting dropout. Patients' body mass index was positively associated with the number of messages exchanged between patients and coaches. No other associations between baseline variables and objective adherence were found.Martina de Zwaan and Anja Hilbert contributed equally to this study.

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Economic evaluation of cognitive behavioral therapy and Internet‐based guided self‐help for binge‐eating disorder

Abstract: We did not find clear evidence for one of the treatments being more cost-effective. CBT tends to be more effective but also more costly. If the societal WTP for an additional BFD is low, then our results suggest that GSH-I should rather be adopted.

Cited by 39 publications

References 32 publications

Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial

Cost-Effectiveness of Facilitated Access to a Self-Management Website, Compared to Usual Care, for Patients With Type 2 Diabetes (HeLP-Diabetes): Randomized Controlled Trial

<p>Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges</p>

Adherence as a predictor of dropout in Internet‐based guided self‐help for adults with binge‐eating disorder and overweight or obesity

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