Clinical and cost‐effectiveness of two ways of delivering guided self‐help for people with an eating disorder: A multi‐arm randomized controlled trial

Abstract

Objective Increasing the availability and accessibility of evidence‐based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost‐effectiveness of guided self‐help via face‐to‐face meetings (fGSH) and a more scalable method, providing support via email (eGSH). Method A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge‐eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost‐effectiveness, binge‐free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. Results Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = −1.32 [95% CI −1.77, −0.87], p < .0001; IRR = −1.62 [95% CI −2.25, −1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost‐effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge‐free day. Discussion Both forms of GSH were associated with clinical improvement and were likely to be cost‐effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non‐completion is greater.

Integrating a web-based intervention into routine care of binge-eating disorder: Study protocol for a randomized controlled trial

“…Based on the effectiveness of online interventions for BED ( Beintner et al, 2014 ; Haderlein, 2022 ), we expect that the program will lead to a greater reduction in the frequency of binge eating episodes over the twelve weeks of treatment compared to a waitlist control condition. Moreover, we assume that there will be a higher decline in global eating disorder symptoms and functional impairments as well as a higher increase in well-being and work capacity in the intervention group compared to the waitlist control group ( Ágh et al, 2015 , Jenkins et al, 2021 , Safi et al, 2022 ). Finally, we expect that the web-based intervention for BED will be associated with a significantly higher reduction in comorbid psychopathology, increased self-esteem, and an improved ability to regulate negative emotions after treatment ( Dingemans et al, 2017 , Linardon et al, 2019 , Prefit et al, 2019 ).…”

“…The WHO-5 assesses general well-being based on five items, rated on a 6-point scale, and has high internal consistency (Cronbach's α = .92; Brähler et al, 2007 ). Changes in w ork capacity : To address the increasing significance of health economic evaluations ( Jenkins et al, 2021 ; Safi et al, 2022 ), changes in work capacity and productivity will be measured based on the iMTA Productivity Cost Questionnaire (iPCQ; Bouwmans et al, 2015 ). The iPCQ examines absences from work and productivity losses due to sickness-related restrictions in work efficiency.…”

Cost-of-illness for non-underweight binge-eating disorders

“…Individuals who, at assessment with the service, met criteria for a diagnosis of BN, BED, or OSFED participated in a randomised controlled trial of guided self-help with few exclusion criteria (see [ 25 ]), and data from these individuals were included in the current study (see Table 1 ). Conduct of the trial was approved by an ethics review board (details are reported elsewhere [ 26 ]) and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.…”

Intervention Tournaments: An Overview of Concept, Design, and Implementation

“…As an example from outside of the social sciences, researchers might design different iterations of polymer networks of the same drug to determine the most effective drug-delivery system (Efentakis & Politis, 2006). In the social sciences, this can be, for example, manipulating the delivery techniques and media style (e.g., providing guided self-help via face-to-face meetings vs. via email to address eating disorders; Jenkins et al, 2021) of the same source materials or examining the optimal dose of an intervention (e.g., one vs. three sessions of exposure therapy to prevent the development of posttraumatic stress disorder; Maples-Keller et al, 2020).…”

“…This highlights the (in-house-developed) intervention tournament as a tool to test different iterations of a similar intervention to zero in on the most effective one. In other words, in most cases, the core is similar, whether it is a drug (Efentakis & Politis, 2006) or the psychological content (Bruneau et al, 2022; Jenkins et al, 2021; Maples-Keller et al, 2020; Milkman et al, 2011; Rosler et al, 2021) that is administered, but the delivery is different in each of these interventions.…”