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Kaplan A, Hutchinson A, Hooper S, Gwee K, Khaw D, Valent L, Willcox JC. Evaluation of an eating disorder screening and care pathway implementation in a general mental health private inpatient setting. J Eat Disord 2024; 12:119. [PMID: 39160580 PMCID: PMC11334319 DOI: 10.1186/s40337-024-01077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/02/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND General mental health inpatient units hold a valuable place in the stepped system of care, and for identification and treatment of people with eating disorders (EDs) or disordered eating behaviours (DEBs). This study aimed to pragmatically evaluate an evidence-informed screening and care pathway, alongside a staff education program, implemented to improve identification and treatment access for consumers with EDs and DEBs, with co-occurring psychiatric conditions, on a general mental health ward. METHODS A mixed methodology design was mapped to the RE-AIM implementation framework. It encompassed medical record audits across two 3-month time points pre and post implementation of the pathway, and key informant consumer and health professional interviews. RESULTS Process and implementation data were compared for three-month periods pre (2019, n = 348) and post-implementation (2021, n = 284). Post-implementation, intake SCOFF screening occurred in 94.7% of admissions. People with ED/DEBs diagnoses were 35 times more likely to have a SCOFF score ≥ 2 (OR = 35.2, p < .001) with the odds of identifying previously undiagnosed DEBs 3.3 times greater (p = .002). Post-implementation, for those with an ED/DEB, dietitian referrals (p < .001) and micronutrient supplementation (p = .013) were more likely. For those with weight and height data, both absolute (-1.1 kg ± 2.2 vs. 1.3 kg ± 2.3; p < .001) and percentage weight change were significantly higher post-implementation with similarities across BMI categories. Universally, consumers and health professionals expressed that the service had "changed care for the better" encouraging therapeutic relationships, mediated by trust, that resulted in better consumer outcomes. 50 health professionals undertook tailored ED and meal support therapy education. They noted that their knowledge and confidence improved allowing value to be seen in understanding EDs and the role for care within general mental health. CONCLUSIONS This study demonstrated that an articulated screening and care pathway could be feasibly implemented in general mental health. The evaluation demonstrated advances in ED detection and management with noted improvements in management access, care planning, physical monitoring and weight gain outcomes. Understanding stakeholders' experiences of new care practices enabled the identification of enablers and barriers for implementation, and avenues to optimise care for consumers with EDs in the general mental health setting.
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Affiliation(s)
- Amy Kaplan
- Epworth HealthCare Rehabilitation and Mental Health, Camberwell, Australia.
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research (QPS), Institute for Health Transformation, Deakin University, Geelong, Australia
- Epworth Healthcare, Richmond, Australia
| | - Suzie Hooper
- Epworth HealthCare Rehabilitation and Mental Health, Camberwell, Australia
| | - Karen Gwee
- Epworth HealthCare Rehabilitation and Mental Health, Camberwell, Australia
| | - Damien Khaw
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research (QPS), Institute for Health Transformation, Deakin University, Geelong, Australia
- Epworth Healthcare, Richmond, Australia
| | - Lola Valent
- Epworth HealthCare Rehabilitation and Mental Health, Camberwell, Australia
| | - Jane C Willcox
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research (QPS), Institute for Health Transformation, Deakin University, Geelong, Australia
- Epworth Healthcare, Richmond, Australia
- Faculty of Health, Charles Darwin University, Darwin, Australia
- Royal Women's Hospital, Parkville, Australia
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Le LKD, Tan EJ, Hay P, Ananthapavan J, Lee YY, Mihalopoulos C. The Modeled Cost-Effectiveness of a Prevention Program Targeting Both Eating Disorders and High BMI. Int J Eat Disord 2024. [PMID: 38975786 DOI: 10.1002/eat.24238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/22/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Prevention programs for eating disorders (EDs) and high body index mass (BMI) have the potential to reduce the onset of these interconnected public health concerns. However, it remains unclear whether routine implementation of such programs would be cost-effective. This study aims to determine the cost-effectiveness of an intervention that aims to prevent both ED and high BMI. METHOD A Markov model was developed to evaluate the incremental cost-effectiveness of a targeted school-based program, Healthy Weight, that aims to prevent both EDs and high BMI among Australian adolescents with body image concerns (aged 15-18 years), versus a "no intervention" comparator. A cost-utility analysis was conducted from a "healthcare and education" sector perspective with costs (measured in 2019 Australian dollars) and health impacts modeled over the lifetime of the target population. An incremental cost-effectiveness ratio (ICER), expressed as cost per health-adjusted life year (HALY) gained, was calculated. Sensitivity analyses were done to test model assumptions. RESULTS The mean intervention cost and HALYs gained were AUD$2.13 million (95% CI, AUD$1.83-2.43 million) and 146 (95% CI, 90-209), respectively. With healthcare cost-savings (AUD$3.97 million) included, the intervention was predicted to be cost-saving (AUD$1.83 million; 95% CI, AUD$0.51-3.21 million). Primary findings were robust to extensive sensitivity analyses. DISCUSSION The Healthy Weight intervention is likely to represent good value-for-money. To ensure the successful implementation of this program at the population level, further research on its feasibility and acceptability among schools and the wider community is required.
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Affiliation(s)
- Long Khanh-Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eng Joo Tan
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
- Camden and Campbelltown Hospital, SWSLHD, Campbelltown, New South Wales, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Yong Yi Lee
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Faller J, Perez JK, Mihalopoulos C, Chatterton ML, Engel L, Lee YY, Le PH, Le LKD. Economic evidence for prevention and treatment of eating disorders: An updated systematic review. Int J Eat Disord 2024; 57:265-285. [PMID: 38111296 DOI: 10.1002/eat.24113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This systematic review updates an existing review examining the cost-effectiveness of interventions to prevent and treat eating disorders (EDs). METHOD Literature search was conducted in Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite, and Health Policy Reference Center electronic databases, capturing studies published between March 2017 to April 2023. Hand-searching was conducted as supplementary including gray literature search. Included articles were (1) full economic evaluations or return-on-investment studies, (2) in English and (3) aimed at prevention and treatment of any ED. Included studies were added and synthesized with previously reviewed studies. Screening and extraction followed PRISMA guidelines. Quality assessment was conducted using the Drummond checklist. PROSPERO registration CRD42021287464. RESULTS A total of 28 studies were identified, including 15 published after the previous review. There were nine prevention, seven anorexia nervosa (AN) treatment, five bulimia nervosa (BN) treatment, four binge-eating disorder (BED), and three non-specific ED treatment studies. Findings indicate value-for-money evidence supporting all interventions. Quality assessment showed studies were fair-to-good quality. DISCUSSION There has been significant growth in cost-effectiveness studies over the last 5 years. Findings suggest that interventions to prevent and treat ED offer value for money. Interventions such as Featback (ED prevention and non-specific ED treatment); focal psychodynamic therapy, enhanced cognitive behavioral therapy, and high-calorie refeeding (AN treatment); stepped-care with assisted self-help and internet-based cognitive behavioral therapy (BN treatment); and cognitive behavioral therapy guided self-help intervention (BED treatment) have good quality economic evidence. Further research in implementation of interventions is required. PUBLIC SIGNIFICANCE STATEMENT The increasing prevalence of ED globally has significant impact on healthcare systems, families, and society. This review is showcasing the value for money of interventions of eating disorders prevention and treatment. This review found that existing interventions offers positive economic benefit for the healthcare system.
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Affiliation(s)
- Jan Faller
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joahna Kevin Perez
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Mary Lou Chatterton
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yong Yi Lee
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Phuong Hong Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hussain MS, Sharma N, Khurana N. An Update on Eating Disorders. CURRENT NUTRITION & FOOD SCIENCE 2024; 20:167-174. [DOI: 10.2174/1573401319666230329135010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/31/2023]
Abstract
Abstract:
It is no surprise that eating disorders (EDs) are increasing all over the planet. With the
emergence of global westernization, development in technology, and societal changes, nearly all
regions of the globe have been influenced by the concept of a perfect body image and height.
EDs are a considerable public concern, a bewilderment for psychologists and a challenge for
physicians. The primary EDs include anorexia nervosa (AN), bulimia nervosa (BN), and binge
eating disorder (BED). AN is an ED that is psychological and possibly life-threatening. Usually,
people with AN experience an exceedingly low body weight due to their height and body shape.
The highest rate of occurrence is between 14 and 17 years of age. BN is an extreme, lifethreatening,
neurological ED in which you have binge eating cycles. You may not have any
sense of balance in your diet throughout these binges. The weight-control engagement of patients
with AN and BN results in various physiological shifts. EDs can control your lives and can be
quite hard to cope with. Yet you will develop a better understanding of who you are by therapy,
return to healthy eating and exercise, and undo any of the severe complications of AN. Investigation
into EDs has yielded valuable new information over the past few decades, notably involving
the psychological features and care of patients. The purpose of this study/review is to expand the
knowledge of the people about these EDs, their global burden, diagnostic criteria, risk factors,
medical complications, management, and the newly added avoidant/restrictive food intake disorder.
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Affiliation(s)
- Md. Sadique Hussain
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Neha Sharma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
| | - Navneet Khurana
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, 144411, Punjab, India
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Martínez de Alva P, Ghaderi A, Andersson G, Feldman I, Sampaio F. The cost-effectiveness of a virtual intervention to prevent eating disorders in young women in Sweden. Int J Eat Disord 2023; 56:1887-1897. [PMID: 37415559 DOI: 10.1002/eat.24018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of a virtual version of the Body Project (vBP), a cognitive dissonance-based program, to prevent eating disorders (ED) among young women with a subjective sense of body dissatisfaction in the Swedish context. METHOD A decision tree combined with a Markov model was developed to estimate the cost-effectiveness of the vBP in a clinical trial population of 149 young women (mean age 17 years) with body image concerns. Treatment effect was modeled using data from a trial investigating the effects of vBP compared to expressive writing (EW) and a do-nothing alternative. Population characteristics and intervention costs were sourced from the trial. Other parameters, including utilities, treatment costs for ED, and mortality were sourced from the literature. The model predicted the costs and quality-adjusted life years (QALYs) related to the prevention of incidence of ED in the modeled population until they reached 25 years of age. The study used both a cost-utility and return on investment (ROI) framework. RESULTS In total, vBP yielded lower costs and larger QALYs than the alternatives. The ROI analysis denoted a return of US $152 for every USD invested in vBP over 8 years against the do-nothing alternative and US $105 against EW. DISCUSSION vBP is likely to be cost-effective compared to both EW and a do-nothing alternative. The ROI from vBP is substantial and could be attractive information for decision makers for implementation of this intervention for young females at risk of developing ED. PUBLIC SIGNIFICANCE This study estimates that the vBP is cost-effective for the prevention of eating disorders among young women in the Swedish setting, and thus is a good investment of public resources.
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Affiliation(s)
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Inna Feldman
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Filipa Sampaio
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Santana DD, Mitchison D, Mannan H, Griffiths S, Appolinario JC, da Veiga GV, Touyz S, Hay P. Twenty-year associations between disordered eating behaviors and sociodemographic features in a multiple cross-sectional sample. Psychol Med 2023; 53:5012-5021. [PMID: 35833367 DOI: 10.1017/s0033291722001994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Disordered eating behaviors (DEB) impact on health and wellbeing worldwide. This study aimed to examine sociodemographic trends in the prevalence of DEB over 20 years in the Australian general population. METHODS Data were derived from five sequential cross-sectional surveys (1998, 2008, 2009, 2016 and 2017) with population-representative samples of adults and adolescents residing in South Australia (N = 15 075). DEBs investigated were objective binge eating (OBE), strict dieting/fasting, and purging. Sociodemographic data included gender, age, educational level, work and marital status, and residence. RESULTS OBE prevalence increased significantly. Strict dieting/fasting also increased from 1998 to 2008/9 but remained stable between 2008/9 and 2016/7. Purging prevalence did not change significantly over time. All survey years were associated with a significantly higher odds of OBE, and strict diet/fasting compared to 1998. Lower age, a higher Accessibility Remoteness Index of Australia (ARIA) score, higher body mass index (BMI), higher educational attainment, and not being in a married or de facto relationship were independently associated with greater adjusted odds for endorsing OBE. Younger age, female gender, and higher BMI were also independently associated with greater adjusted odds for endorsing strict dieting/fasting. CONCLUSIONS The increased prevalence of DEBs in various strata of Australian society has both public health and clinical implications. The results refute the stereotype that eating disorders (EDs) predominantly affect young women. They build impetus for future research on EDs among men and older individuals, with a view to developing tailored public health and clinical interventions for these populations.
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Affiliation(s)
- Danilo Dias Santana
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- School of Medicine, Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Deborah Mitchison
- Department of Psychology, Centre for Emotional Health, Macquarie University, New South Wales, Australia
- Camden and Campbelltown Hospitals, SWSLHD, New South Wales, Australia
| | - Haider Mannan
- School of Medicine, Translational Health Research Institute, Western Sydney University, New South Wales, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Jose Carlos Appolinario
- Group of Obesity and Eating Disorders, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gloria Valeria da Veiga
- Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Stephen Touyz
- School of Psychology, University of Sydney, New South Wales, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, New South Wales, Australia
- Camden and Campbelltown Hospitals, SWSLHD, New South Wales, Australia
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Le LKD, Faller J, Chatterton ML, Perez JK, Chiotelis O, Tran HNQ, Sultana M, Hall N, Lee YY, Chapman C, Newton N, Slade T, Sunderland M, Teesson M, Mihalopoulos C. Interventions to prevent alcohol use: systematic review of economic evaluations. BJPsych Open 2023; 9:e117. [PMID: 37365798 DOI: 10.1192/bjo.2023.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Alcohol use is a leading risk factor for death and disability worldwide. AIMS We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan. METHOD Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist. RESULTS A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults. CONCLUSIONS Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.
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Affiliation(s)
- Long Khanh-Dao Le
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Jan Faller
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Mary Lou Chatterton
- PharmD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Joahna Kevin Perez
- MHE, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Oxana Chiotelis
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Huong Ngoc Quynh Tran
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Marufa Sultana
- PhD, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Natasha Hall
- MHE, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Australia
| | - Yong Yi Lee
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia; School of Public Health, The University of Queensland, Australia; and Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Cath Chapman
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Nicola Newton
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Tim Slade
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Matt Sunderland
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Maree Teesson
- PhD, Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Australia
| | - Cathrine Mihalopoulos
- PhD, Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Australia
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Aouad P, Ahmed MU, Nassar N, Miskovic-Wheatley J, Touyz S, Maguire S, Cunich M. Appraisal of the costs, health effects, and cost-effectiveness of screening, prevention, treatment and policy-indicated evidence-based interventions for eating disorders: a systematic review protocol. J Eat Disord 2023; 11:83. [PMID: 37226270 DOI: 10.1186/s40337-023-00802-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 05/06/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Having reliable information to make decisions about the allocation of healthcare resources is needed to improve well-being and quality-of-life of individuals with eating disorders (EDs). EDs are a main concern for healthcare administrators globally, particularly due to the severity of health effects, urgent and complex healthcare needs, and relatively high and long-term healthcare costs. A rigorous assessment of up-to-date health economic evidence on interventions for EDs is essential for informing decision-making in this area. To date, health economic reviews on this topic lack a comprehensive assessment of the underlying clinical utility, type and amount of resources used, and methodological quality of included economic evaluations. The current review aims to (1) detail the type of costs (direct and indirect), costing approaches, health effects, and cost-effectiveness of interventions for EDs; (2) assess the nature and quality of available evidence to provide meaningful insights into the health economics associated with EDs. METHODS All interventions for screening, prevention, treatment, and policy-based approaches for all Diagnostic and Statistics Manual (DSM-IV and DSM-5) listed EDs among children, adolescents, and adults will be included. A range of study designs will be considered, including randomised controlled trials, panel studies, cohort studies, and quasi-experimental trials. Economic evaluations will consider key outcomes, including type of resources used (time and valued in a currency), costs (direct and indirect), costing approach, health effects (clinical and quality-of-life), cost-effectiveness, economic summaries used, and reporting and quality assessments. Fifteen general academic and field-specific (psychology and economics) databases will be searched using subject headings and keywords that consolidate costs, health effects, cost-effectiveness and EDs. Quality of included clinical studies will be assessed using risk-of-bias tools. Reporting and quality of the economic studies will be assessed using the widely accepted Consolidated Health Economic Evaluation Reporting Standards and Quality of Health Economic Studies frameworks, with findings of the review presented in tables and narratively. DISCUSSION Results emanating from this systematic review are expected to highlight gaps in healthcare interventions/policy-focused approaches, under-estimates of the economic costs and disease-burden, potential under-utilisation of ED-related resources, and a pressing need for more complete health economic evaluations.
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Affiliation(s)
- Phillip Aouad
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia.
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia.
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia.
| | - Moin Uddin Ahmed
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Natasha Nassar
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Stephen Touyz
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Maguire
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Michelle Cunich
- MAINSTREAM Centre for Health System Research & Translation in Eating Disorders Collaboration, InsideOut Institute, University of Sydney, Sydney, NSW, Australia
- InsideOut Institute, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
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9
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Prevention and early intervention in eating disorders: findings from a rapid review. J Eat Disord 2023; 11:38. [PMID: 36899428 PMCID: PMC9999654 DOI: 10.1186/s40337-023-00758-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/19/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. METHODS This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. RESULTS In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. CONCLUSIONS Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.
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10
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Long MW, Ward ZJ, Wright DR, Rodriguez P, Tefft NW, Austin SB. Cost-Effectiveness of 5 Public Health Approaches to Prevent Eating Disorders. Am J Prev Med 2022; 63:935-943. [PMID: 36109308 DOI: 10.1016/j.amepre.2022.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Eating disorders cause suffering and a high risk of death. Accelerating the translation of research into implementation will require intervention cost-effectiveness estimates. The objective of this study was to estimate the cost-effectiveness of 5 public health approaches to preventing eating disorders among adolescents and young adults. METHODS Using data from 2001 to 2017, the authors developed a microsimulation model of a closed cohort starting at the age of 10 years and ending at 40 years. In 2021, an analysis was conducted of 5 primary and secondary prevention strategies for eating disorders: school-based screening, primary care‒based screening, school-based universal prevention, excise tax on over-the-counter diet pills, and restriction on youth purchase of over-the-counter diet pills. The authors estimated the reduction in years lived with eating disorders and the increase in quality-adjusted life-years. Intervention costs and net monetary benefit were estimated using a threshold of $100,000/quality-adjusted life year. RESULTS All the 5 interventions were estimated to be cost-saving compared with the current practice. Discounted per person cost savings (over the 30-year analytic time horizon) ranged from $63 (clinic screening) to $1,102 (school-based universal prevention). Excluding caregiver costs for binge eating disorder and otherwise specified feeding and eating disorders substantially reduced cost savings (e.g., from $1,102 to $149 for the school-based intervention). CONCLUSIONS A range of public health strategies to reduce the societal burden of eating disorders are likely cost saving. Universal prevention interventions that promote healthy nutrition, physical activity, and media use behaviors without introducing weight stigma may prevent additional negative health outcomes, such as excess weight gain.
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Affiliation(s)
- Michael W Long
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia.
| | - Zachary J Ward
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Davene R Wright
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Patricia Rodriguez
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington
| | | | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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11
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Svendsen VG, Lokkerbol J, Danner U, Jansingh A, Evers SM, Wijnen BF. Design and testing of a health economic Markov model for treatment of anorexia nervosa. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1243-1251. [PMID: 36047856 DOI: 10.1080/14737167.2022.2119130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Anorexia Nervosa (AN) is a severe psychiatric disorder and knowledge about the cost-effectiveness of potential interventions is limited. The aim of this paper is to introduce the Trimbos Institute health economic cost-effectiveness model for Anorexia Nervosa (AnoMod-TI), a flexible modelling tool for assessing the long-term cost-effectiveness of interventions for AN in late adolescent and adult patients, which could support clinical decision making. METHODS AnoMod-TI is a state-transition cohort simulation (Markov) model developed from a Dutch societal perspective, which consists of four health states - namely full remission (FR), partial remission (PR), AN and death. Results are expressed as total healthcare costs, QALYs and incremental cost-effectiveness ratio. RESULTS For the purpose of demonstrating AnoMod-TI and how it could be used to estimate cost-effectiveness over a 20-year time horizon, it was applied to a hypothetical treatment scenario. Results illustrate how a relatively costly intervention with only modest effects can still be cost-effective in the long term. CONCLUSIONS AnoMod -TI can be used to examine long-term cost-effectiveness of various interventions aimed at either treating AN or preventing relapse from a state of partial or full remission. AnoMod-TI is freely available upon request to the authors.
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Affiliation(s)
- Vegard G Svendsen
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.,Norwegian Centre for Addiction Research, SERAF, University of Oslo, Oslo, Norway
| | - Joran Lokkerbol
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Unna Danner
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Silvia Maa Evers
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Health Services Research, Care and Public Health Research, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Ben Fm Wijnen
- Center for Economic Evaluation & Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands.,Department of Clinical and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Trompeter N, Bussey K, Forbes MK, Hay P, Goldstein M, Thornton C, Basten C, Heruc G, Roberts M, Byrne S, Griffiths S, Lonergan A, Mitchison D. Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents. Res Child Adolesc Psychopathol 2022; 50:683-694. [PMID: 35029782 PMCID: PMC9054869 DOI: 10.1007/s10802-022-00898-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.
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Affiliation(s)
- Nora Trompeter
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Kay Bussey
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Mandy Goldstein
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | | | - Christopher Basten
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Gabriella Heruc
- School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
| | - Marion Roberts
- School of Population Health, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Byrne
- School of Psychological Sciences, University of Western Australia, Perth, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexandra Lonergan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Deborah Mitchison
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.,School of Medicine, Translational Health Research Institute, Western Sydney University, Camden and Campbelltown Hospital, SWSLHD, Sydney, Campbelltown, Australia
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13
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van den Berg E, Schlochtermeier D, Koenders J, de Mooij L, de Jonge M, Goudriaan AE, Blankers M, Peen J, Dekker J. Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study. J Eat Disord 2022; 10:2. [PMID: 34991730 PMCID: PMC8734258 DOI: 10.1186/s40337-021-00526-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. METHODS Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012-2014, and the other (N = 88) CBT-E between 2015-2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. RESULTS Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76-1.9], p < .001). CONCLUSIONS In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.
| | - Daniela Schlochtermeier
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands
| | - Jitske Koenders
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands
| | - Liselotte de Mooij
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Novarum Center for Eating Disorders and Obesity, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, The Netherlands.,Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jaap Peen
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands.,Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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14
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Yang Y, Conti J, McMaster CM, Hay P. Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review. Nutrients 2021; 13:nu13124490. [PMID: 34960041 PMCID: PMC8706437 DOI: 10.3390/nu13124490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian’s role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment.
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Affiliation(s)
- Yive Yang
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
| | - Janet Conti
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
- School of Psychology, Western Sydney University, Penrith, NSW 2750, Australia
| | - Caitlin M. McMaster
- University of Sydney Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, Westmead, NSW 2145, Australia;
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia; (Y.Y.); (J.C.)
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Sydney, NSW 2560, Australia
- Correspondence:
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15
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Wolter V, Hammerle F, Buerger A, Ernst V. Prevention of eating disorders-Efficacy and cost-benefit of a school-based program ("MaiStep") in a randomized controlled trial (RCT). Int J Eat Disord 2021; 54:1855-1864. [PMID: 34498304 DOI: 10.1002/eat.23599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Given the severity of eating disorders, effective and easily implementable prevention programs which reduce incidence rates and in addition have health-economic benefits are essential. The majority of research on prevention programs focuses on questionnaire-based efficacy or the reduction of eating disorder symptoms while neglecting the health-economic perspective. By contrast, the present study focuses on both an efficacy analysis considering diagnostic criteria (DSM-5) and on evaluating the cost-benefit of a universal prevention program for eating disorders ("MaiStep"). METHOD A three-arm randomized controlled trial with baseline, posttreatment and 12-month follow-up was conducted with 1,654 adolescents (M = 13.35, SD = 0.76), comprising two intervention groups (MaiStep delivered by psychologists or teachers, IG-T) and an active control group (ACG). The primary outcome was DSM-5 eating disorder diagnosis measured with the SIAB-S. Furthermore, the costs of the prevention program and the savings in health care costs were calculated. RESULTS A significant difference in eating disorder diagnosis was found between the IG-T and the ACG for posttreatment (χ2 (1= 7.352, p = .007), Relative Risk (RR) = .53 and 12-month follow-up (χ2 (1= 5.203, p = .023), RR = .61. MaiStep proved to be cost-effective (tcbr = 6.75), saving about 560,000 € (standardized per 1,000 students = 601,388.19 €). DISCUSSION Universal prevention can both reduce incidence rates of eating disorders and be cost-beneficial for health care systems. Future research should analyze prevention programs regarding efficacy and cost-benefit to enable comparability and derive guidelines for political decision-makers. TRIAL REGISTRATION NUMBER MaiStep is registered at the German Clinical Trials Register (DRKS00005050).
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Affiliation(s)
- Vanessa Wolter
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Florian Hammerle
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arne Buerger
- German Centre of Prevention Research in Mental Health, University of Wuerzburg, Wuerzburg, Germany.,Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Verena Ernst
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Geilhufe B, Tripp O, Silverstein S, Birchfield L, Raimondo M. Gender-Affirmative Eating Disorder Care: Clinical Considerations for Transgender and Gender Expansive Children and Youth. Pediatr Ann 2021; 50:e371-e378. [PMID: 34542335 DOI: 10.3928/19382359-20210820-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Transgender and gender expansive (TGE) children and youth suffer staggering rates of discrimination and are at higher risk of developing eating disorder symptoms and behaviors than cisgender youth. This article presents an overview of current research on identified risk factors for the development of eating disorders for TGE children and youth; provides clinical considerations for professionals in providing gender-affirming, collaborative eating disorder care; outlines specific concepts for staff training and for developing gender-affirming systems of care including policies and practices; and identifies numerous resources for TGE children and youth and their families. The clinical considerations and suggested practices reflect current research and clinical practice. Both the gender-affirmative clinical field and the eating disorder field are constantly evolving, and the recommendations and resources will need ongoing updates to reflect developments in these fields. [Pediatr Ann. 2021;50(9):e371-e378.].
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17
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Jenkins PE, Luck A, Violato M, Robinson C, Fairburn CG. Clinical and cost-effectiveness of two ways of delivering guided self-help for people with an eating disorder: A multi-arm randomized controlled trial. Int J Eat Disord 2021; 54:1224-1237. [PMID: 33998020 DOI: 10.1002/eat.23554] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH). METHOD A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge-eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. RESULTS Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p < .0001; IRR = -1.62 [95% CI -2.25, -1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day. DISCUSSION Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amy Luck
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Byford S, Petkova H, Barrett B, Ford T, Nicholls D, Simic M, Gowers S, Macdonald G, Stuart R, Livingstone N, Kelly G, Kelly J, Joshi K, Smith H, Eisler I. Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study. J Eat Disord 2021; 9:76. [PMID: 34174952 PMCID: PMC8235580 DOI: 10.1186/s40337-021-00433-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa. METHOD Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves. RESULTS Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome. CONCLUSIONS Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS. TRIAL REGISTRATION ISRCTN12676087 . Date of registration 07/01/2014.
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Affiliation(s)
- Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK.
| | - Hristina Petkova
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Level 5 Clifford Allbutt Building, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0AH, UK
| | - Dasha Nicholls
- Imperial College London, Division of Psychiatry, Department of Brain Sciences, Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
| | - Simon Gowers
- University of Liverpool, Mount Pleasant, Liverpool, L69 3BX, UK
| | - Geraldine Macdonald
- University of Bristol, School for Policy Studies, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - Ruth Stuart
- Institute of Psychiatry, Psychology & Neuroscience at King's College London, PO24 David Goldberg Centre, De Crespigny Park, London, SE5 8AF, UK
| | - Nuala Livingstone
- Queen's University Belfast, School of Social Sciences, Education & Social Work, 6 College Park Ave, Belfast, BT7 1PS, UK
| | - Grace Kelly
- Queen's University Belfast, University Road, Belfast, BT7 1NN, UK
| | - Jonathan Kelly
- Beat, Unit 1 Chalk Hill House, 19 Rosary Road, Norwich, Norfolk, NR1 1SZ, UK
| | - Kandarp Joshi
- NHS Grampian and University of Aberdeen, CAMHS, City Hospital, Park Road, Aberdeen, AB24 5AU, UK
| | - Helen Smith
- NHS Ayrshire and Arran, South CAMHS/NSAIU, CAMHS, Arrol Park Resource Centre, House 1, Doonfoot Road, Ayr, KA7 2DW, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, Maudsley Centre for Child and Adolescent Eating Disorders, Michael Rutter Centre for Children and Young People, De Crespigny Park, London, SE5 8AZ, UK
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Cost-Effectiveness Comparison of Delivery Modalities for a Dissonance-Based Eating Disorder Prevention Program over 4-Year Follow-Up. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:1086-1095. [PMID: 34152570 DOI: 10.1007/s11121-021-01264-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
The cost-effectiveness of delivery methods for an eating disorder prevention program is reported. In an effectiveness trial (enrollment 2013-2015) comparing three formats (clinician-led, peer-led, and Internet-delivered) for delivering the Body Project eating disorder prevention program to college women versus an educational video control, the peer-led method was more effective than the three alternatives at preventing onset of eating disorders over 4-year follow-up. Eating disorder incidence was 19.3% for clinician-led groups, 8.1% for peer-led groups, 15.5% for Internet-based eBody Project participants, and 17.6% for educational video controls. Delivery costs per person are reported for the Body Project, including participant time, and the cost-effectiveness is calculated for peer-led groups versus the video control. Data analyses were conducted in 2019-2021. Delivery costs per person for the Body Project, including participant time, were approximately $96 for clinician-led groups, $80 for peer-led groups, and $22 for the eBody Project, compared with $9 for the educational video control. For each additional case of eating disorder onset that was prevented by the peer-led groups, compared with the video control, the cost was about $740. There were no differences in health care utilization across condition. Eating disorder prevention costs via the Body Project compare very favorably with the costs for treating an eating disorder, which previously have been estimated to range from approximately $20,300 for cognitive-behavioral therapy for bulimia nervosa to approximately $119,200 for adequate care treatment of anorexia nervosa. These analyses demonstrate the economic value of the Body Project for preventing eating disorders among college-age women when delivered in peer-facilitated groups. ClinicalTrials.gov Identifier: NCT01949649.
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Tannous WK, Hay P, Girosi F, Heriseanu AI, Ahmed MU, Touyz S. The economic cost of bulimia nervosa and binge eating disorder: a population-based study. Psychol Med 2021; 52:1-15. [PMID: 33998425 DOI: 10.1017/s0033291721000775] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. METHOD Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. RESULTS The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. CONCLUSIONS The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.
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Affiliation(s)
- Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Federico Girosi
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Andreea I Heriseanu
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
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Le LKD, Mihalopoulos C. Putting a dollar value on eating disorders: What is next?: Commentary on Streatfeild et al. (2021). Int J Eat Disord 2021; 54:869-871. [PMID: 33759223 DOI: 10.1002/eat.23507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 01/23/2023]
Abstract
Eating disorders (EDs) have been associated with economic and quality of life burden. Several cost-of-illness studies has been reported, however, the study by Streatfeild et al. (2021) for the first time provided a comprehensive analysis of the economic burden of EDs in the United States. This study provides an opportunity to highlight the critical need for evaluating effectiveness and cost-effectiveness of preventive and treatment interventions for EDs. However, to be able to do, this further enhancement and inclusion of EDs into population health surveillance and health services data are required. While there were some limitations in the cost-of-illness study undertaken by Streatfeild et al. (2021), it does nonetheless present very reasonable recommendations as to what is required next. We agree that the likely impacts and costs of EDs are substantive and there is certainly a strong case for further research investment in this traditionally underinvested area.
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Affiliation(s)
- Long Khanh-Dao Le
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
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Le LKD, Esturas AC, Mihalopoulos C, Chiotelis O, Bucholc J, Chatterton ML, Engel L. Cost-effectiveness evidence of mental health prevention and promotion interventions: A systematic review of economic evaluations. PLoS Med 2021; 18:e1003606. [PMID: 33974641 PMCID: PMC8148329 DOI: 10.1371/journal.pmed.1003606] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 05/25/2021] [Accepted: 03/31/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The prevention of mental disorders and promotion of mental health and well-being are growing fields. Whether mental health promotion and prevention interventions provide value for money in children, adolescents, adults, and older adults is unclear. The aim of the current study is to update 2 existing reviews of cost-effectiveness studies in this field in order to determine whether such interventions are cost-effective. METHODS AND FINDINGS Electronic databases (including MEDLINE, PsycINFO, CINAHL, and EconLit through EBSCO and Embase) were searched for published cost-effectiveness studies of prevention of mental disorders and promotion of mental health and well-being from 2008 to 2020. The quality of studies was assessed using the Quality of Health Economic Studies Instrument (QHES). The protocol was registered with PROSPERO (# CRD42019127778). The primary outcomes were incremental cost-effectiveness ratio (ICER) or return on investment (ROI) ratio across all studies. A total of 65 studies met the inclusion criteria of a full economic evaluation, of which, 23 targeted children and adolescents, 35 targeted adults, while the remaining targeted older adults. A large number of studies focused on prevention of depression and/or anxiety disorders, followed by promotion of mental health and well-being and other mental disorders. Although there was high heterogeneity in terms of the design among included economic evaluations, most studies consistently found that interventions for mental health prevention and promotion were cost-effective or cost saving. The review found that targeted prevention was likely to be cost-effective compared to universal prevention. Screening plus psychological interventions (e.g., cognitive behavioural therapy [CBT]) at school were the most cost-effective interventions for prevention of mental disorders in children and adolescents, while parenting interventions and workplace interventions had good evidence in mental health promotion. There is inconclusive evidence for preventive interventions for mental disorders or mental health promotion in older adults. While studies were of general high quality, there was limited evidence available from low- and middle-income countries. The review was limited to studies where mental health was the primary outcome and may have missed general health promoting strategies that could also prevent mental disorder or promote mental health. Some ROI studies might not be included given that these studies are commonly published in grey literature rather than in the academic literature. CONCLUSIONS Our review found a significant growth of economic evaluations in prevention of mental disorders or promotion of mental health and well-being over the last 10 years. Although several interventions for mental health prevention and promotion provide good value for money, the varied quality as well as methodologies used in economic evaluations limit the generalisability of conclusions about cost-effectiveness. However, the finding that the majority of studies especially in children, adolescents, and adults demonstrated good value for money is promising. Research on cost-effectiveness in low-middle income settings is required. TRIAL REGISTRATION PROSPERO registration number: CRD42019127778.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
- * E-mail:
| | - Adrian Cuevas Esturas
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Oxana Chiotelis
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Jessica Bucholc
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Mary Lou Chatterton
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Lidia Engel
- Deakin University, Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
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Golden NH, Cheng J, Kapphahn CJ, Buckelew SM, Machen VI, Kreiter A, Accurso EC, Adams SH, Le Grange D, Moscicki AB, Sy AF, Wilson L, Garber AK. Higher-Calorie Refeeding in Anorexia Nervosa: 1-Year Outcomes From a Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-037135. [PMID: 33753542 PMCID: PMC8015147 DOI: 10.1542/peds.2020-037135] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We recently reported the short-term results of this trial revealing that higher-calorie refeeding (HCR) restored medical stability earlier, with no increase in safety events and significant savings associated with shorter length of stay, in comparison with lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa. Here, we report the 1-year outcomes, including rates of clinical remission and rehospitalizations. METHODS In this multicenter, randomized controlled trial, eligible patients admitted for medical instability to 2 tertiary care eating disorder programs were randomly assigned to HCR (2000 kcals per day, increasing by 200 kcals per day) or LCR (1400 kcals per day, increasing by 200 kcals every other day) within 24 hours of admission and followed-up at 10 days and 1, 3, 6, and 12 months post discharge. Clinical remission at 12 months post discharge was defined as weight restoration (≥95% median BMI) plus psychological recovery. With generalized linear mixed effect models, we examined differences in clinical remission over time. RESULTS Of 120 enrollees, 111 were included in modified intent-to-treat analyses, 60 received HCR, and 51 received LCR. Clinical remission rates changed over time in both groups, with no evidence of significant group differences (P = .42). Medical rehospitalization rates within 1-year post discharge (32.8% [19 of 58] vs 35.4% [17 of 48], P = .84), number of rehospitalizations (2.4 [SD: 2.2] vs 2.0 [SD: 1.6]; P = .52), and total number of days rehospitalized (6.0 [SD: 14.8] vs 5.1 [SD: 10.3] days; P = .81) did not differ by HCR versus LCR. CONCLUSIONS The finding that clinical remission and medical rehospitalization did not differ over 1-year, in conjunction with the end-of-treatment outcomes, support the superior efficacy of HCR as compared with LCR.
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Affiliation(s)
- Neville H. Golden
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jing Cheng
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California
| | - Cynthia J. Kapphahn
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sara M. Buckelew
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Vanessa I. Machen
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Anna Kreiter
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | - Sally H. Adams
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
| | - Daniel Le Grange
- Psychiatry and Behavioral Sciences,,Department of Psychiatry and Behavioral Neuroscience, School of Medicine, The University of Chicago, Chicago, Illinois; and
| | - Anna-Barbara Moscicki
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Allyson F. Sy
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Leslie Wilson
- Medicine, and Clinical Pharmacy, University of California, San Francisco, San Francisco, California
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Departments of Pediatrics
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Lascar R, Letranchant A, Hirot F, Godart N. [What factors explain the length of hospitalization for anorexia nervosa: A systematic review]. Encephale 2021; 47:362-368. [PMID: 33752870 DOI: 10.1016/j.encep.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The cost of hospital treatment for anorexia nervosa (AN) is very high given its duration. Identifying factors related to length of hospital stay (LOS) would make it possible to consider targeted therapeutic strategies that, by optimizing care, would reduce their duration and costs. The objective of this work is to identify the factors related (predictive and associated) to LOS for AN. METHODS Systematic review of existing literature up to October 2020, based on Pubmed, according to PRISMA recommendations (Preferred Reported Items for Systematic reviews and Meta-Analysis). Factors related to LOS have been described in two categories: factors related to clinical aspects ; and factors related to therapeutic aspects and management modalities. We distinguished predictive factors (identified as pre-hospitalization or contemporaneous with hospital admission) and associated factors (observed during hospitalization) for each category. RESULTS Thirteen articles were selected. Samples from the selected studies ranged from 35 to 381 subjects, mostly women with restrictive type AN (R-AN), but some samples included all types of AN, or focused on purging-type forms. The mean age at admission ranged from 13.6 years (Standard Deviation-SD:±1.6) to 30.3 years (SD :±13.9), corresponding to adolescent, adult or mixed samples. Mean body mass indices at admission ranged from 12.3 (SD±1.4) to 16.6 (SD:±2.1). The duration of disease progression ranged from 11.7 months±2.2 to 9.7 years. Mean LOS are short for studies conducted in pediatrics or in medical services (ranging from 13.0 days [SD±7.3] to 22.1 days [SD±9.4]); they are more variable for studies conducted in psychiatry: from 15.6 days (SD±1.0) to 150.2 days (SD±80.8). Among the factors related to an increase in LOS, clinical predictors included: older age at onset or admission; longer duration of the disorder; low minimum body weight during AN; low BMI at admission; purgative form of anorexia nervosa; and high levels of dietary symptoms (asceticism and ineffectiveness dimensions on Eating Disorder Inventory-2). Therapeutic and management modality predictive factors were: a higher number of hospitalizations for AN; the use of enteral nutrition (nasogastric or percutaneous gastric tube) on admission or during hospitalization; the use of intravenous renutrition coupled with oral renutrition; hospitalization far from the patient's home; absence of hospital care in psychiatry after medical stabilization in a somatic unit; compulsory hospitalization. Associated factors were: the presence of psychiatric comorbidities; greater weight gain during hospitalization. Among the factors related to a decrease in LOS, the clinical predictive factor were: greater self-confidence at admission (measured by the Eating Disorder Recovery Self-Efficacy Questionnaire). Therapeutic and management modality predictors included: increased caloric intake of oral renutrition on admission; intake of oral nutritional supplements on admission; and hospitalization in urban areas. The associated factor was: compliance with the weight contract in the adolescent population. DISCUSSION Factors related to an increase in LOS are explained by: higher resistance to treatment, higher severity of the disease, the time required for weight gain in services using cognitive-behavioural therapy, complications associated with renutrition modalities such as parenteral renutrition, difficulties in organising outpatient follow-up which require better consolidation of inpatient treatment and the lack of multidisciplinary care in medical services. Factors related to a decrease in LOS are due to: faster weight gain, the presence of a greater number of outpatient follow-up structures close to the hospital and better adherence to treatment to complete the weight contract. CONCLUSIONS Taking these factors into account during hospitalization for AN would help optimize care, duration and costs. This situation therefore requires the development of therapeutic trials targeting the identified factors in order to reduce LOS in the treatment of AN.
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Affiliation(s)
- R Lascar
- Faculté de médecine de Nice, UNS Santé, 28, avenue de Valombrose, 06107 Nice, France; Faculté de médecine, université Paris Sud XI, 63, rue Gabriel Péri, 94270 le Kremlin-Bicêtre, France.
| | - A Letranchant
- Département de psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - F Hirot
- Service hospitalo-universitaire de santé mentale de l'adolescent et du jeune adulte, Fondation Santé Des Étudiants de France, Paris, France; UFR Health Sciences Simone Veil, UVSQ, Saint-Quentin en Yvelynes, France; CESP, Inserm 1178, Paris-Sud University, UVSQ, Paris-Saclay University, Villejuif, France
| | - N Godart
- Département de psychiatrie, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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Le LKD, Mihalopoulos C, Engel L, Touyz S, González-Chica DA, Stocks N, Hay P. Burden and health state utility values of eating disorders: results from a population-based survey. Psychol Med 2021; 51:130-137. [PMID: 31670627 DOI: 10.1017/s0033291719003064] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND There are no published estimates of the health state utility values (HSUVs) for a broad range of eating disorders (EDs). HSUVs are used in economic evaluations to determine quality-adjusted life years or as a measure of disorder burden. The main objective of the current study is to present HSUVs for a broad range of EDs based on DSM-5 diagnoses. METHODS We used pooled data of two Health Omnibus Surveys (2015 and 2016) including representative samples of individuals aged 15 + years living in South Australia. HSUVs were derived from the SF-6D (based on the SF-12 health-related quality of life questionnaire) and analysed by ED classification, ED symptoms (frequency of binge-eating or distress associated to binge eating) and weight status. Multiple linear regression models, adjusted for socio-demographics, were used to test the differences of HSUVs across ED groups. RESULTS Overall, 18% of the 5609 individuals met criteria for ED threshold and subthreshold. EDs were associated with HSUV decrements, especially if they were severe disorders (compared to non-ED), binge ED: -0.16 (95% CI -0.19 to -0.13), bulimia nervosa: -0.12, (95% CI -0.16 to -0.08). There was an inverse relationship between distress related binge eating and HSUVs. HSUVs were lower among people with overweight/obese compared to those with healthy weight regardless of ED diagnosis. CONCLUSIONS EDs were significantly associated with lower HSUVs compared to people without such disorders. This study, therefore, provides new insights into the burden of EDs. The derived HSUVs can also be used to populate future economic models.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Lidia Engel
- Deakin University, Geelong, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Geelong, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, the University of Sydney, Camperdown, New South Wales, Australia
| | - David Alejandro González-Chica
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
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The majority of professionally active women diagnosed with eating disorders may be at risk of work addiction: an overlooked comorbidity. HEALTH PSYCHOLOGY REPORT 2021. [DOI: 10.5114/hpr.2020.98734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Le LKD, Hay P, Ananthapavan J, Lee YY, Mihalopoulos C. Assessing the Cost-Effectiveness of Interventions That Simultaneously Prevent High Body Mass Index and Eating Disorders. Nutrients 2020; 12:nu12082313. [PMID: 32752114 PMCID: PMC7468897 DOI: 10.3390/nu12082313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 01/25/2023] Open
Abstract
Eating disorders (ED) are among the top three most common debilitating illnesses in adolescent females, while high Body Mass Index (BMI) is one of the five leading modifiable risk factors for preventable disease burden. The high prevalence of eating and weight-related problems in adolescence is of great concern, particularly since this is a period of rapid growth and development. Here, we comment on the current evidence for the prevention of EDs and high BMI and the importance of assessing the cost-effectiveness of interventions that integrate the prevention of EDs and high BMI in this population. There is evidence that there are effective interventions targeted at children, adolescents and young adults that can reduce the prevalence of risk factors associated with the development of EDs and high BMI concurrently. However, optimal decision-making for the health of younger generations involves considering the value for money of these effective interventions. Further research investigating the cost-effectiveness of potent and sustainable integrated preventive interventions for EDs and high BMI will provide decision makers with the necessary information to inform investment choices.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia; (J.A.); (Y.Y.L.); (C.M.)
- Correspondence: ; Tel.: +61-392468383
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia;
- Camden and Campbelltown Hospital, SWSLHD, Campbelltown, NSW 2560, Australia
| | - Jaithri Ananthapavan
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia; (J.A.); (Y.Y.L.); (C.M.)
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia
| | - Yong Yi Lee
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia; (J.A.); (Y.Y.L.); (C.M.)
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD 4076, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria 3125, Australia; (J.A.); (Y.Y.L.); (C.M.)
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Schmidt M, Werbrouck A, Verhaeghe N, Putman K, Simoens S, Annemans L. Universal Mental Health Interventions for Children and Adolescents: A Systematic Review of Health Economic Evaluations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:155-175. [PMID: 31605299 DOI: 10.1007/s40258-019-00524-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Effective mental health interventions may reduce the impact that mental health problems have on young people's well-being. Nevertheless, little is known about the cost effectiveness of such interventions for children and adolescents. OBJECTIVES The objectives of this systematic review were to summarize and assess recent health economic evaluations of universal mental health interventions for children and adolescents aged 6-18 years. METHODS Four electronic databases were searched for relevant health economic studies, using a pre-developed search algorithm. Full health economic evaluations evaluating the cost effectiveness of universal mental health interventions were included, as well as evaluations of anti-bullying and suicide prevention interventions that used a universal approach. Studies on the prevention of substance abuse and those published before 2013 fell outside the scope of this review. Study results were summarised in evidence tables, and each study was subject to a systematic quality appraisal. RESULTS Nine studies were included in the review; in six, the economic evaluation was conducted alongside a clinical trial. All studies except one were carried out in the European Union, and all but one evaluated school-based interventions. All evaluated interventions led to positive incremental costs compared to their comparators and most were associated with small increases in quality-adjusted life-years. Almost half of the studies evaluated the cost effectiveness of cognitive behavioural therapy-based interventions aimed at the prevention of depression or anxiety, with mixed results. Cost-effectiveness estimates for a parenting programme, a school-based social and emotional well-being programme and anti-bullying interventions were promising, though the latter were only evaluated for the Swedish context. Drivers of cost effectiveness were implementation costs; intervention effectiveness, delivery mode and duration; baseline prevalence; and the perspective of the evaluation. The overall study quality was reasonable, though most studies only assessed short-term costs and effects. CONCLUSION Few studies were found, which limits the possibility of drawing strong conclusions about cost effectiveness. There is some evidence based on decision-analytic modelling that anti-bullying interventions represent value for money. Generally, there is a lack of studies that take into account long-term costs and effects. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42019115882.
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Affiliation(s)
- Masja Schmidt
- Department of Public Health, Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Amber Werbrouck
- Department of Public Health and Primary Care, Interuniversity Center for Health Economics Research, Ghent University, Ghent, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Nick Verhaeghe
- Department of Public Health, Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
- Department of Public Health and Primary Care, Interuniversity Center for Health Economics Research, Ghent University, Ghent, Belgium
| | - Koen Putman
- Department of Public Health, Interuniversity Center for Health Economics Research, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Interuniversity Center for Health Economics Research, Ghent University, Ghent, Belgium
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van den Berg E, Schlochtermeier D, Koenders J, de Mooij L, Goudriaan A, Blankers M, Peen J, Dekker J. Implementing cognitive behavioral therapy-enhanced in a routine inpatient and outpatient setting: Comparing effectiveness and treatment costs in two consecutive cohorts. Int J Eat Disord 2020; 53:461-471. [PMID: 31998992 DOI: 10.1002/eat.23229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Even though evidence-based interventions can enhance clinical outcomes and cost effectiveness, in the field of eating disorders, implementation of empirically supported treatments (ESTs) in routine inpatient and outpatient settings is slow. OBJECTIVE This study examined differential (cost-) effectiveness, after implementing evidence-based cognitive behavioral therapy-enhanced (CBT-E) throughout a Dutch treatment center. METHOD Two consecutive cohorts of adult patients, BMI between 17.5 and 40, were compared, with one cohort (N = 239) receiving treatment-as-usual (TAU) between 2012 and 2014 and the other (N = 320) receiving CBT-E between 2015 and 2017. RESULTS Eating disorder pathology, measured with self-reports, decreased significantly in both cohorts; overall, no differences in clinical outcomes between both cohorts were found. Treatment costs and treatment duration were considerably lower in 2015-2017. When limiting the cost analysis to direct costs, there is a 71% likelihood that CBT-E is more cost-effective and a 29% likelihood that CBT-E leads to fewer remissions at lower costs, based on the distribution of the cost-effectiveness plane. The likelihood that TAU leads to lower costs is 0%. DISCUSSION Findings show that implementing an EST throughout inpatient and outpatient settings leads to lower costs with similar treatment effect and has the advantage of shorter treatment duration and a shorter inpatient stay.
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Affiliation(s)
- Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amsterdam, The Netherlands
| | | | - Jitske Koenders
- Novarum Center for Eating Disorders & Obesity, Amsterdam, The Netherlands
| | - Liselotte de Mooij
- Novarum Center for Eating Disorders & Obesity, Amsterdam, The Netherlands
| | - Anneke Goudriaan
- Novarum Center for Eating Disorders & Obesity, Amsterdam, The Netherlands.,Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Jaap Peen
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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30
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Sudres JL, Bordet A, Brandibas G. Art-thérapie et troubles des conduites alimentaires. Évaluation en follow-up. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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31
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Byford S, Petkova H, Stuart R, Nicholls D, Simic M, Ford T, Macdonald G, Gowers S, Roberts S, Barrett B, Kelly J, Kelly G, Livingstone N, Joshi K, Smith H, Eisler I. Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.
Objectives
The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.
Design
Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.
Setting
Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.
Participants
A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.
Interventions
Community-based specialist eating disorders services and generic CAMHS.
Main outcome measures
Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.
Data sources
Data were collected by clinicians from clinical records.
Results
Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied.
Limitations
Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses.
Conclusions
The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers.
Future work
Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services.
Trial registration
Current Controlled Trials ISRCTN12676087.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dasha Nicholls
- Department of Medicine, Imperial College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Institute of Health Research, Department of Psychological Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Sarah Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Grace Kelly
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nuala Livingstone
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Kandarp Joshi
- Child and Adolescent Mental Health Service, Royal Cornhill Hospital, NHS Grampian, Aberdeen, UK
- Mental Health Division, University of Aberdeen, Aberdeen, UK
| | | | - Ivan Eisler
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
There has been sporadic research on eating disorders in India, with no published attempt to collate and summarize the literature landscape. Hence, the present narrative review aims to summarize Indian work related to eating disorders, discern current trends, and highlight gaps in research that will provide directions for future work in the area. Electronic search using the MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles, in October 2018, using combinations of the following medical subject headings or free text terms: "eating disorders," "anorexia nervosa," "bulimia," "treatment," "epidemiology," "co-morbidity," "management," "medications," "behavioral intervention," and "psychosocial intervention." The data extracted from studies included details such as author names, year, from which of the states in India the work originated, type of intervention (for interventional studies), comparator (if any), and major outcomes. There is increasing research focused on eating disorders from India over the last decade, but it continues to be an under-researched area as evidenced by the relative paucity of original research. The cultural differences between east and west have contributed to variations in the presentation as well as challenges in the diagnosis. Hence, there is a need for the development of culturally sensitive instruments for diagnosis, as well as generating locally relevant epidemiological data about eating disorders from community and hospital settings.
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Affiliation(s)
- Sivapriya Vaidyanathan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pooja Patnaik Kuppili
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
The authors provide an overview of the current state of research on self-help interventions for eating disorders. The efficacy of different forms of self-help interventions for bulimia nervosa, binge eating disorder, and other eating disorders at various stages of the care pathway (from prevention to relapse prevention) is described. Cost-effectiveness studies are also presented. Moderators of outcome, such as guidance and adherence, are discussed. Overall, the findings are promising and support the use of self-help interventions in the treatment of bulimic disorders, across the stages of the care pathway. Less is known about the use of self-help in anorexia nervosa.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK.
| | - Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK; The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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34
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Pietrabissa G, Castelnuovo G, Jackson JB, Rossi A, Manzoni GM, Gibson P. Brief Strategic Therapy for Bulimia Nervosa and Binge Eating Disorder: A Clinical and Research Protocol. Front Psychol 2019; 10:373. [PMID: 30906269 PMCID: PMC6418034 DOI: 10.3389/fpsyg.2019.00373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Although cognitive behavioral therapy is the gold standard treatments for bulimia nervosa (BN) and binge eating disorder (BED), evidence for its long-term efficacy is weak. Empirical research support the efficacy of brief strategic therapy (BST) in treating BN and BED symptoms, but its statistical significance still need to be investigated. Objective: To statistically test the long-term efficacy of the BST treatment protocols for BN and BED through one-year post-treatment. Methods: A two-group longitudinal study will be conducted. Participants will be sequentially recruited for inclusion in a state-funded community psychotherapy clinic. Multilevel growth curve modeling will be used to estimate the average growth trajectories from baseline to one year after treatment termination for the severity of the BN and BED features as measured by the Eating Disorder Examination Questionnaire. Discussion: Findings from this study will clarify the impact of BST in treating BN and BED symptoms. Conclusion: Translating research into practice may inform how to ensure high-quality patient care.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Jeffrey B Jackson
- Department of Human Development and Family Science, Virginia Tech, Falls Church, VA, United States
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padua, Padua, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Faculty of Psychology, eCampus University, Novedrate, Italy
| | - Padraic Gibson
- Bateson Clinic, Dublin, Ireland.,Hesed House, Dublin, Ireland
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35
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Bauer S, Bilić S, Reetz C, Ozer F, Becker K, Eschenbeck H, Kaess M, Rummel-Kluge C, Salize HJ, Diestelkamp S, Moessner M. Efficacy and cost-effectiveness of Internet-based selective eating disorder prevention: study protocol for a randomized controlled trial within the ProHEAD Consortium. Trials 2019; 20:91. [PMID: 30700318 PMCID: PMC6354385 DOI: 10.1186/s13063-018-3161-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/22/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth. METHODS The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed. DISCUSSION This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018.
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Affiliation(s)
- Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Sally Bilić
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Christina Reetz
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Fikret Ozer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University Marburg and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University Marburg, Marburg, Germany
| | - Heike Eschenbeck
- Department of Psychology, University of Education Schwäbisch Gmünd, Oberbettringer Str. 200, 73525 Schwäbisch Gmünd, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Blumenstraße 8, 69115 Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Stöckli, 3000 Bern 60, Switzerland
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Hans-Joachim Salize
- Mental Health Services Research Group, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159 Mannheim, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W29, 20246 Hamburg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
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36
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Abstract
Poor mental health has profound economic consequences. Given the burden of poor mental health, the economic case for preventing mental illness and promoting better mental health may be very strong, but too often prevention attracts little attention and few resources. This article describes the potential role that can be played by economic evidence alongside experimental trials and observational studies, or through modeling, to substantiate the need for increased investment in prevention. It illustrates areas of action across the life course where there is already a good economic case. It also suggests some further areas of substantive public health concern, with promising effectiveness evidence, that may benefit from economic analysis. Financial and economic barriers to implementation are then presented, and strategies to address the barriers and increase investment in the prevention of mental illness are suggested.
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Affiliation(s)
- David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
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37
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Abstract
This article reviews the 10 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2018. Two models frame this analysis. This first is the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment (recovery). The second parses the phases of prevention into rationale, theory, and methodology → clarification of risk factors, including very high risk, shading into warning signs → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. Collectively, the articles illustrate how complex and demanding the field of prevention is, with respect to, for example, phases of program development, the multidimensional ecology of interventions, and methodological requirements for demonstrating that a program deserves to be designated "evidence-based." A subset of the articles also illustrates how far the increasingly broad and dynamic field of prevention has advanced. Examples include models of eating disorder development in high-risk populations such as people with type 1 diabetes; prevention programming for young children; and after-school preventive interventions that combine dissonance-based lessons with empowering participation in community advocacy and activism.
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Affiliation(s)
- Michael P Levine
- a Department of Psychology , Kenyon College , Gambier , Ohio , USA
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