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Cost-Effectiveness of Internet-Based Cognitive-Behavioral Treatment for Bulimia Nervosa: Results of a Randomized Controlled Trial.

Authors
  • Watson, Hunna J1, 2, 3, 4, 5
  • McLagan, Nicole6
  • Zerwas, Stephanie C2
  • Crosby, Ross D7, 8
  • Levine, Michele D9
  • Runfola, Cristin D2, 10
  • Peat, Christine M2, 11
  • Moessner, Markus12
  • Zimmer, Benjamin12
  • Hofmeier, Sara M2
  • Hamer, Robert M2, 13
  • Marcus, Marsha D6
  • Bulik, Cynthia M2, 14, 15
  • Crow, Scott J16, 17
  • 1 Department of Psychiatry, The University of North Carolina at Chapel Hill, CB #7160, 101 Manning Dr, Chapel Hill, NC 27599. [email protected]
  • 2 Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 3 Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 4 School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia. , (Australia)
  • 5 School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia. , (Australia)
  • 6 Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Western Australia, Australia. , (Australia)
  • 7 Neuropsychiatric Research Institute, Fargo, North Dakota, USA.
  • 8 Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
  • 9 Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • 10 Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, USA.
  • 11 Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 12 Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany. , (Germany)
  • 13 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 14 Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  • 15 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. , (Sweden)
  • 16 Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
  • 17 The Emily Program, St Paul, Minnesota, USA.
Type
Published Article
Journal
The Journal of Clinical Psychiatry
Publisher
"Physicians Postgraduate Press, Inc."
Publication Date
Jan 01, 2018
Volume
79
Issue
1
Identifiers
DOI: 10.4088/JCP.16m11314
PMID: 29228517
Source
Medline
Language
English
License
Unknown

Abstract

To evaluate the cost-effectiveness of Internet-based cognitive-behavioral therapy for bulimia nervosa (CBT-BN) compared to face-to-face delivery of CBT-BN. This study is a planned secondary analysis of data from a randomized clinical trial. Participants were 179 adults (98% female, mean age = 28 years) meeting DSM-IV criteria for bulimia nervosa who were randomized to group face-to-face or group Internet-based CBT-BN for 16 sessions during 20 weeks. The cost-effectiveness analysis was conducted from a third-party payor perspective, and a partial societal perspective analysis was conducted to investigate cost-utility (ie, cost per gain in quality-adjusted life-years) and patient out-of-pocket travel-related costs. Net health care costs were calculated from protocol and nonprotocol health care services using third-party payor cost estimates. The primary outcome measure in the clinical trial was abstinence from binge eating and purging, and the trial start and end dates were 2008 and 2016. The mean cost per abstinent patient at posttreatment was $7,757 (95% confidence limit [CL], $4,515, $13,361) for face-to-face and $11,870 (95% CL, $6,486, $22,188) for Internet-based CBT-BN, and at 1-year follow-up was $16,777 (95% CL, $10,298, $27,042) for face-to-face and $14,561 (95% CL, $10,165, $21,028) for Internet-based CBT-BN. There were no statistically significant differences between treatment arms in cost-effectiveness or cost-utility at posttreatment or 1-year follow-up. Out-of-pocket patient costs were significantly higher for face-to-face (mean [95% CL] = $178 [$127, $140]) than Internet-based ($50 [$50, $50]) therapy. Third-party payor cost-effectiveness of Internet-based CBT-BN is comparable with that of an accepted standard. Internet-based dissemination of CBT-BN may be a viable alternative for patients geographically distant from specialist eating disorder services who have an unmet need for treatment. ClinicalTrials.gov identifier: NCT00877786​. © Copyright 2017 Physicians Postgraduate Press, Inc.

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