Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents

Byford, Sarah; Barrett, Barbara; Roberts, Chris; Clark, Andrew; Edwards, Vanessa; Smethurst, Nicola; Gowers, Simon

doi:10.1192/bjp.bp.107.036806

Cited by 103 publications

(107 citation statements)

References 21 publications

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“…Group sessions, where parents and children were seen separately, were most often used in the treatment of eating disorders (25)(26)(27). On the other hand, family therapies designed to treat mental health disorders or substance use disorders usually comprised family sessions with a therapist.…”

Section: Design Of Interventionsmentioning

confidence: 99%

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Tubeuf

Guthmuller

2017

Global & Regional Health Technology Assessment

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Section: Design Of Interventionsmentioning

confidence: 99%

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Tubeuf

Guthmuller

2017

Global & Regional Health Technology Assessment

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“…The high level of admission in the non-specialist care pathway raises a number of concerns. Inpatient treatment of AN is costly, 354,364 has high relapse rates, 228,365 and there is evidence that hospital treatment is associated with poor outcomes in adolescent AN even when severity of symptoms are controlled for. 353 …”

Section: Admissions For Inpatient Treatmentmentioning

confidence: 99%

“…Although there is commonly some on-site education, such long hospitalisations can mean that young people spend long stretches of time out of education. 354 It seems that, in the face of severe illness, education often comes second, although this is a concern for parents 385 and seen as an important determinant of quality of life. 386 There is some evidence that the illness does not affect educational outcomes in the longer term: there was no statistically significant difference between young women with AN and their healthy co-twins 5 years after recovery from AN, 387 and a greater proportion of patients admitted to hospital with AN than of controls had completed post-secondary education.…”

Section: Study 3: Economic Outcomes Of Anorexia Nervosa In a British mentioning

confidence: 99%

“…31 Studies of inpatient care have found no evidence of specific benefits arising out of hospital treatment in comparison with outpatient care, 352 and there is some evidence that prolonged admissions may result in poorer outcome, 353 as well as being more costly. 354 There is considerable variability in the treatment provisions for children and adolescents suffering from AN in the UK, ranging from outpatient treatment provided within general CAMHS to highly specialised ED services. The only RCT to compare general and specialist outpatient services, the Treatment Outcome for Child and adolescent Anorexia Nervosa trial, found no difference in clinical outcomes between services.…”

Section: Introductionmentioning

confidence: 99%

“…354,372 This compared the costs and outcomes of inpatient treatment, specialist outpatient treatment and TAU and found that specialist outpatient treatment had a higher probability of being cost-effective (up to approximately 60%). One limitation of this study was that only 65% of patients adhered to the allocated treatment.…”

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confidence: 99%

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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs

et al. 2015

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IMPORTANCE Accountable care payment models aim to reduce total direct medical expenses for high-cost patients through improved quality of care and preventive health services. Little is known about health care expenditures of privately insured adolescents, especially those who incur high costs.OBJECTIVES To assess health care expenditures for high-cost adolescents and to describe the patient characteristics associated with high medical costs. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort analysis was conducted of data from January 1 to December 31, 2012, of 13 103 privately insured adolescents aged 13 to 21 years (mean [SD] age, 16.3 [2.4] years; 6764 [51.6%] males) at 82 independent pediatric primary care practices in Massachusetts. Analysis was conducted from April 1, 2014, to April 1, 2015. MAIN OUTCOMES AND MEASURESWe compared demographic (age, sex, median income by zip code) and clinical (obesity, behavioral health problem, complex chronic condition) characteristics between high-cost (top 1%) and non-high-cost adolescents. We assigned high-cost adolescents to clinical categories using software from the Agency for Healthcare Research and Quality to describe clinically relevant patterns of spending.RESULTS Total direct medical expenses were $41.2 million for the entire cohort and a median $1167 per patient. A total of 132 (1.0%) patients with the highest costs accounted for 23.6% of expenses of the cohort, with a median $52 577 per patient. Mental health disorders were the most common diagnosis in high-cost patients; 78 (59.1%) of these patients had at least 1 behavioral health diagnosis. Pharmacy costs accounted for 28.4% of total direct medical expenses of high-cost patients; primary care accounted for 1.0%. Characteristics associated with being a high-cost patient included having 1 complex chronic condition (relative risk [RR], 6.5; 95% CI, 4.7-9.0), having 2 or more complex chronic conditions (RR, 23.5; 95% CI, 14.2-39.1), having any behavioral health diagnosis (RR, 3.6; 95% CI, 2.6-5.1), and obesity (RR, 2.0; 95% CI, 1.3-3.0). CONCLUSIONS AND RELEVANCETotal direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity. Cost reduction strategies in similar populations should be tailored to these cost drivers.

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Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents

Abstract: On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa.

Cited by 103 publications

References 21 publications

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Economic Evaluation of Family-Based Therapies for Children and Adolescents: what do we know?

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Total Direct Medical Expenses and Characteristics of Privately Insured Adolescents Who Incur High Costs

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