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



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.



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.



Depending on the WTP, FPT proved cost-effective in the treatment of adult AN.
Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
N
N
Egger
Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany.
B
B
Wild
Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany.
S
S
Zipfel
Department of Psychosomatic Medicine and Psychotherapy,University Hospital Tübingen,Tübingen,Germany.
F
F
Junne
Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
A
A
Konnopka
Section of Eating Disorders,Department of Psychological Medicine,King's College London,London,UK.
U
U
Schmidt
Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Hannover,Germany.
M
M
de Zwaan
Department of Psychosomatic Medicine and Psychotherapy,LWL-University Clinic Bochum, Ruhr-University Bochum,Bochum,Germany.
S
S
Herpertz
Department of Psychosomatic Medicine and Psychotherapy,University Hospital Freiburg,Freiburg,Germany.
A
A
Zeeck
Department of Psychosomatic Medicine and Psychotherapy,University Medical Center Hamburg-Eppendorf, and Schön Klinik Hamburg-Eilbek,Hamburg,Germany.
B
B
Löwe
Department of Psychosomatic Medicine and Psychotherapy,University Hospital of Ulm,Ulm,Germany.
J
J
von Wietersheim
Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen,Essen,Germany.
S
S
Tagay
Department of Psychosomatics and Psychotherapy,University Hospital Münster,Münster,Germany.
M
M
Burgmer
Department of Psychosomatic Medicine and Psychotherapy,Klinikum rechts der Isar, Technische Universität München,Munich,Germany.
A
A
Dinkel
Department of General Internal Medicine and Psychosomatics,Heidelberg University Hospital,Heidelberg,Germany.
W
W
Herzog
Department of Health Economics and Health Services Research,Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf,Hamburg,Germany.
H-H
HH
König
D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D000856:Anorexia Nervosa / Q000191:economics / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D005858:Germany; D006760:Hospitalization / Q000191:economics; D006801:Humans; D064889:Psychotherapy, Psychodynamic / Q000191:economics / Q000379:methods*; D055815:Young Adult
Anorexia nervosa; cognitive therapy; cost effectiveness; psychodynamic psychotherapy