N Egger1, B Wild2, S Zipfel3, F Junne3, A Konnopka1, U Schmidt4, M de Zwaan5, S Herpertz6, A Zeeck7, B Löwe8, J von Wietersheim9, S Tagay10, M Burgmer11, A Dinkel12, W Herzog2, H-H König1. 1. Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany. 2. Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany. 3. Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany. 4. Section of Eating Disorders,Department of Psychological Medicine,King's College London,London,UK. 5. Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Hannover,Germany. 6. Department of Psychosomatic Medicine and Psychotherapy,LWL-University Clinic Bochum, Ruhr-University Bochum,Bochum,Germany. 7. Department of Psychosomatic Medicine and Psychotherapy,University Hospital Freiburg,Freiburg,Germany. 8. Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf, and Schön Klinik Hamburg-Eilbek,Hamburg,Germany. 9. Department of Psychosomatic Medicine and Psychotherapy,University Hospital of Ulm,Ulm,Germany. 10. Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen,Essen,Germany. 11. Department of Psychosomatics and Psychotherapy,University Hospital Münster,Münster,Germany. 12. Department of Psychosomatic Medicine and Psychotherapy,Klinikum rechts der Isar, Technische Universität München,Munich,Germany.
Abstract
BACKGROUND:Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. METHOD: The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. RESULTS: Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. CONCLUSIONS: Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
RCT Entities:
BACKGROUND:Anorexia nervosa (AN) is a serious illness leading to substantial morbidity and mortality. The treatment of AN very often is protracted; repeated hospitalizations and lost productivity generate substantial economic costs in the health care system. Therefore, this study aimed to determine the differential cost-effectiveness of out-patient focal psychodynamic psychotherapy (FPT), enhanced cognitive-behavioural therapy (CBT-E), and optimized treatment as usual (TAU-O) in the treatment of adult women with AN. METHOD: The analysis was conducted alongside the randomized controlled Anorexia Nervosa Treatment of OutPatients (ANTOP) study. Cost-effectiveness was determined using direct costs per recovery at 22 months post-randomization (n = 156). Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated. To derive cost-effectiveness acceptability curves (CEACs) adjusted net-benefit regressions were applied assuming different values for the maximum willingness to pay (WTP) per additional recovery. Cost-utility and assumptions underlying the base case were investigated in exploratory analyses. RESULTS: Costs of in-patient treatment and the percentage of patients who required in-patient treatment were considerably lower in both intervention groups. The unadjusted ICERs indicated FPT and CBT-E to be dominant compared with TAU-O. Moreover, FPT was dominant compared with CBT-E. CEACs showed that the probability for cost-effectiveness of FTP compared with TAU-O and CBT-E was ⩾95% if the WTP per recovery was ⩾€9825 and ⩾€24 550, respectively. Comparing CBT-E with TAU-O, the probability of being cost-effective remained <90% for all WTPs. The exploratory analyses showed similar but less pronounced trends. CONCLUSIONS: Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
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