The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching

Abstract

Outpatient care (e.g., individual, group, or self‐help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self‐efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost‐effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.

Eating Disorder Day Programs: Is There a Best Format?

“…While we did not make directional hypotheses, previous evaluations of ED treatment which included DPs [26] showed that greater support for patient autonomy increased the motivation of patients, which leads to better outcomes. Extrapolation from the critique offered by Ali and colleagues [13] would also suggest that such changes might enhance outcomes.…”

“…Thus, outcomes can be more confidently attributed to the treatment formats provided. In the future, it would be valuable to compare the outcomes of the DP in the current study to inpatient and outpatient treatments, as it has been consistently identified in the literature that there is limited research on clinical outcomes and, in particular, comparisons of different intensities of treatment [13].…”

“…A recent critique of DP [13] suggested that there are potential disadvantages to consider. These include costs (patient time, staffing, food for meals), and undermining patient autonomy through use of a structured and strict schedule of programs and menus.…”

Day‐hospital enhanced cognitive behavior therapy for adults with eating disorders: Immediate and follow‐up effects

“…Future studies should compare day-hospital CBT-E with "treatment as usual" to assess the true efficacy of the former. Furthermore, to test less expensive forms of stepped care approaches, as suggested by Ali et al (2021), non-responders to outpatient treatment could be randomized to day-hospital or treatment conclusion with the option to return to outpatient care when their motivation to change improves. However, according to our results, day-hospital CBT-E seems a promising alternative to inpatient treatment for patients with eating disorders not responding to outpatient treatment.…”

Shining a light on ideas worth researching in the field of eating disorders: Introduction to a Virtual Issue of the International Journal of Eating Disorders

“…Supportive Psychotherapy), far fewer studies have examined whether and when to provide treatment in the form of intensive day treatment versus outpatient treatment. In their Spotlight focused on these two most commonly employed in‐person delivery formats, Ali et al (2021) make the case that while the extant literature suggests that either format is clinically effective in improving outcomes in adult patients, the field is lacking cost‐effectiveness studies. Comparative studies are needed to test whether the greater costs of day treatment (e.g., due to direct costs related to the increased staff involvement, more extensive infrastructure, and indirect costs related to patients spending more time away from school, work or family duties) can be justified based on potentially superior patient outcomes (e.g., higher percent of patients who recover; shorter time to recovery; lower rates of relapse; etc.).…”