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Cost-effectiveness of focal psychodynamic therapy and enhanced cognitive–behavioural therapy in out-patients with anorexia nervosa

Published online by Cambridge University Press:  09 September 2016

N. Egger ,
B. Wild ,
S. Zipfel ,
F. Junne ,
A. Konnopka ,
U. Schmidt ,
M. de Zwaan ,
S. Herpertz ,
A. Zeeck  and
B. Löwe
...Show all authors
N. Egger*
Affiliation:
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
B. Wild
Affiliation:
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
S. Zipfel
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
F. Junne
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
A. Konnopka
Affiliation:
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
U. Schmidt
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, King's College London, London, UK
M. de Zwaan
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
S. Herpertz
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic Bochum, Ruhr-University Bochum, Bochum, Germany
A. Zeeck
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Hospital Freiburg, Freiburg, Germany
B. Löwe
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, and Schön Klinik Hamburg-Eilbek, Hamburg, Germany
J. von Wietersheim
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
S. Tagay
Affiliation:
Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany
M. Burgmer
Affiliation:
Department of Psychosomatics and Psychotherapy, University Hospital Münster, Münster, Germany
A. Dinkel
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
W. Herzog
Affiliation:
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
H.-H. König
Affiliation:
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
*
*Address for correspondence: N. Egger, Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. (Email: n.egger@uke.de)
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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.

Keywords

Anorexia nervosacognitive therapycost effectivenesspsychodynamic psychotherapy
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3291 - 3301
Copyright
Copyright © Cambridge University Press 2016 

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