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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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References

Abbate-Daga, G, Amianto, F, Delsedime, N, De-Bacco, C, Fassino, S (2013). Resistance to treatment and change in anorexia nervosa [corrected]: a clinical overview. BMC Psychiatry 13, 294.CrossRefGoogle ScholarPubMed
Abbate-Daga, G, Facchini, F, Marzola, E, Delsedime, N, Giovannone, C, Amianto, F, Fassino, S (2014). Health-related quality of life in adult inpatients affected by anorexia nervosa. European Eating Disorders Review 22, 285–291.CrossRefGoogle ScholarPubMed
Ackard, DM, Richter, S, Egan, A, Engel, S, Cronemeyer, CL (2014). The meaning of (quality of) life in patients with eating disorders: a comparison of generic and disease-specific measures across diagnosis and outcome. International Journal of Eating Disorders 47, 259–267.CrossRefGoogle ScholarPubMed
Azur, MJ, Stuart, EA, Frangakis, C, Leaf, PJ (2011). Multiple imputation by chained equations: what is it and how does it work? International Journal of Methods in Psychiatric Research 20, 40–49.CrossRefGoogle ScholarPubMed
Brooks, A, Hagen, SE, Sathyanarayanan, S, Schultz, AB, Edington, DW (2010). Presenteeism: critical issues. Journal of Occupational and Environmental Medicine 52, 1055–1067.CrossRefGoogle ScholarPubMed
Byford, S, Barrett, B, Roberts, C, Clark, A, Edwards, V, Smethurst, N, Gowers, SG (2007). Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents. British Journal of Psychiatry 191, 436–440.CrossRefGoogle ScholarPubMed
Chisholm, D, Knapp, MR, Knudsen, HC, Amaddeo, F, Gaite, L, van Wijngaarden, B (2000). Client Socio-Demographic and Service Receipt Inventory – European Version: development of an instrument for international research. EPSILON Study 5. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs. British Journal of Psychiatry 39, s28–s33.CrossRefGoogle Scholar
Crow, S (2014). The economics of eating disorder treatment. Current Psychiatry Reports 16, 454.CrossRefGoogle ScholarPubMed
de Jong, P, Heller, GZ (2008). Generalized Linear Models for Insurance Data. Cambridge University Press: Cambridge, UK.CrossRefGoogle Scholar
Dejong, H, Broadbent, H, Schmidt, U (2012). A systematic review of dropout from treatment in outpatients with anorexia nervosa. International Journal of Eating Disorders 45, 635–647.CrossRefGoogle ScholarPubMed
Deutsche Krankenhausgesellschaft (2009). Bestandsaufnahme zur Krankenhausplanung und Investitionsfinanzierung in den Bundesländern. Deutsche Krankenhausgesellschaft: Berlin.Google Scholar
Dolan, P (1997). Modeling valuations for EuroQol health states. Medical Care 35, 1095–1108.CrossRefGoogle ScholarPubMed
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. The Guilford Press: New York and London.Google ScholarPubMed
Fenwick, E, O'Brien, BJ, Briggs, A (2004). Cost-effectiveness acceptability curves – facts, fallacies and frequently asked questions. Health Economics 13, 405–415.CrossRefGoogle ScholarPubMed
Fichter, M, Quadflieg, N (2001). The Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. European Psychiatry 16, 38–48.CrossRefGoogle ScholarPubMed
Friederich, HC, Herzog, W, Wild, B, Zipfel, S, Schauenburg, H (2014). Anorexia Nervosa. Fokale psychodynamische Psychotherapie. Hogrefe: Göttingen.Google Scholar
Graham, JW, Olchowski, AE, Gilreath, TD (2007). How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prevention Science 8, 206–213.CrossRefGoogle ScholarPubMed
Gray, AM (2011). Applied Methods of Cost-Effectiveness Analysis in Health Care. Oxford University Press: Oxford.Google Scholar
Hoch, JS, Briggs, AH, Willan, AR (2002). Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost-effectiveness analysis. Health Economics 11, 415–430.CrossRefGoogle Scholar
Hoch, JS, Rockx, MA, Krahn, AD (2006). Using the net benefit regression framework to construct cost-effectiveness acceptability curves: an example using data from a trial of external loop recorders versus Holter monitoring for ambulatory monitoring of “community acquired” syncope. BMC Health Services Research 6, 68.CrossRefGoogle ScholarPubMed
Kessler, RC, Ames, M, Hymel, PA, Loeppke, R, McKenas, DK, Richling, DE, Stang, PE, Ustun, TB (2004). Using the World Health Organization Health and Work Performance Questionnaire (HPQ) to evaluate the indirect workplace costs of illness. Journal of Occupational and Environmental Medicine 46, S23–S37.CrossRefGoogle ScholarPubMed
Krauth, C, Hessel, F, Hansmeier, T, Wasem, J, Seitz, R, Schweikert, B (2005). Empirical standard costs for health economic evaluation in Germany – a proposal by the working group methods in health economic evaluation. Gesundheitswesen 67, 736–746.CrossRefGoogle Scholar
Legenbauer, T, Vocks, S (2005). Manual der kognitiven Verhaltenstherapie bei Anorexie und Bulimie. Springer: Berlin.Google Scholar
Nan, L, Johnson, JA, Shaw, JW, Coons, SJ (2007). A comparison of EQ-5D index scores derived from the US and UK population-based scoring functions. Medical Decision Making 27, 321–326.CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2004). National Institute for Health and Clinical Excellence: guidance. In Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders, pp. 64–65. British Psychological Society: UK, The British Psychological Society & The Royal College of Psychiatrists: Leicester.Google Scholar
Raghunathan, TE, Lepkowski, JM, Van Hoewyk, J, Solenberger, P (2001). A multivariate technique for multiply imputing missing values using a sequence of regression models. Survey Methodology 27, 85–95.Google Scholar
Rote Liste Service GmbH (2008). Rote Liste 2008. Arzneimittelverzeichnis für Deutschland. Rote Liste Service GmbH: Frankfurt am Main.Google Scholar
Statistisches Bundesamt (2008). Pflegestatistik 2007. Statistisches Bundsamt: Wiesbaden.Google Scholar
Statistisches Bundesamt (2009 a). Kostennachweis der Krankenhäuser 2008. Statistisches Bundesamt: Wiesbaden.Google Scholar
Statistisches Bundesamt (2009 b). Grunddaten der Krankenhäuser 2008. Statistisches Bundesamt: Wiesbaden.Google Scholar
Statistisches Bundesamt (2009 c). Verdienste und Arbeitskosten. Statistisches Bundesamt: Wiesbaden.Google Scholar
Statistisches Bundesamt (2010). Volkswirtschaftliche Gesamtrechnungen 2009. Statistisches Bundesamt: Wiesbaden.Google Scholar
Stuhldreher, N, Konnopka, A, Wild, B, Herzog, W, Zipfel, S, Lowe, B, Konig, HH (2012). Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. International Journal of Eating Disorders 45, 476–491.CrossRefGoogle ScholarPubMed
van Buuren, S, Groothuis-Oudshoorn, K (2011). mice: Multiple imputation by chained equations in R. Journal of Statistical Software 45, 1–67.Google Scholar
Wild, B, Friederich, HC, Gross, G, Teufel, M, Herzog, W, Giel, KE, de Zwaan, M, Schauenburg, H, Schade-Brittinger, C, Schafer, H, Zipfel, S (2009). The ANTOP study: focal psychodynamic psychotherapy, cognitive–behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa – a randomized controlled trial. Trials 10, 23.CrossRefGoogle ScholarPubMed
Wu, M, Brazier, JE, Kearns, B, Relton, C, Smith, C, Cooper, CL (2015). Examining the impact of 11 long-standing health conditions on health-related quality of life using the EQ-5D in a general population sample. European Journal of Health Economics 16, 141–151.CrossRefGoogle Scholar
Zerwas, S, Larsen, JT, Petersen, L, Thornton, LM, Mortensen, PB, Bulik, CM (2015). The incidence of eating disorders in a Danish register study: associations with suicide risk and mortality. Journal of Psychiatric Research 65, 16–22.CrossRefGoogle Scholar
Zethraeus, N, Johannesson, M, Jonsson, B, Lothgren, M, Tambour, M (2003). Advantages of using the net-benefit approach for analysing uncertainty in economic evaluation studies. Pharmacoeconomics 21, 39–48.CrossRefGoogle ScholarPubMed
Zipfel, S, Giel, KE, Bulik, CM, Hay, P, Schmidt, U (2015). Anorexia nervosa: aetiology, assessment, and treatment. Lancet Psychiatry 2, 1099–1111.CrossRefGoogle ScholarPubMed
Zipfel, S, Wild, B, Gross, G, Friederich, HC, Teufel, M, Schellberg, D, Giel, KE, de Zwaan, M, Dinkel, A, Herpertz, S, Burgmer, M, Löwe, B, Tagay, S, von Wietersheim, J, Zeeck, A, Schade-Brittinger, C, Schauenburg, H, Herzog, W; ANTOP study group (2014). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial. Lancet 383, 127–137.CrossRefGoogle ScholarPubMed