title: Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial.
abstract: OBJECTIVE
  To investigate the cost-utility of the internet-based intervention "Featback" provided with different levels of therapist support, in comparison to a waiting list.
  
  
  METHODS
  This economic evaluation was conducted from a societal perspective and was part of a randomized controlled trial in which participants (N = 354) with self-reported ED symptoms were randomized to: (1) 8 weeks of Featback, consisting of psychoeducation and a fully automated monitoring- and feedback system, (2) Featback with low-intensity (weekly) therapist support, (3) Featback with high-intensity (three times a week) therapist support, and (4) a waiting list. Participants were assessed at baseline, postintervention, and 3-month follow-up. Cost-utility acceptability curves were constructed.
  
  
  RESULTS
  No significant differences between the study conditions were found regarding quality-adjusted life-years (P = 0.55) and societal costs (P = 0.45), although the mean costs per participant were lowest in the Featback condition with low-intensity therapist support (€1951), followed by Featback with high-intensity therapist support (€2032), Featback without therapist support (€2102), and the waiting list (€2582). Featback seemed to be cost-effective as compared to the waiting list. No clear preference was found for Featback with or without therapist support.
  
  
  CONCLUSIONS
  A fully automated Internet-based intervention for ED symptoms with no, low-, or high-intensity therapist support represented good value for money when compared to a waiting list. This finding may have important implications for clinical practice, as both the unguided- and guided intervention could allow for more efficient care and widespread dissemination, potentially increasing the accessibility and availability of mental health care services for individuals with ED symptoms. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1068-1076).
authors.affiliation: Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Aardoom
authors.affiliation: Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Dingemans
authors.affiliation: Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: van Ginkel
authors.affiliation: Institute of Psychology, Leiden University, Leiden, The Netherlands.|Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Spinhoven
authors.affiliation: Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.|Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: E F
authors.identifier: http://orcid.org/0000-0002-1131-0886
authors.initials: EF
authors.lastname: Van Furth
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: Van den Akker-van Marle
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D001068:Feeding and Eating Disorders / Q000191:economics / Q000628:therapy*; D005260:Female; D006282:Health Personnel / Q000191:economics; D006801:Humans; D020407:Internet / Q000191:economics*; D008297:Male; D010353:Patient Education as Topic / Q000191:economics / Q000379:methods; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D057566:Self Report; D012944:Social Support; D014850:Waiting Lists; D055815:Young Adult
keywords: E-health; Internet-based intervention; cost-utility; eating disorders; economic evaluation; quality of life; randomized controlled trial; therapist support