TY - JOUR
T1 - The cost-effectiveness of cognitive behavioral therapy for bulimia nervosa in the Australian context
AU - Le, Long Khanh Dao
AU - Hay, Phillipa
AU - Wade, Tracey
AU - Touyz, Stephen
AU - Mihalopoulos, Cathrine
N1 - Funding Information:
National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant, Grant Number: APP1041131; Centre of Research Excellence in Mental Health Systems Improvement (CREMSI) and Deakin University Postgraduate Scholarship; NHMRC Early Career Fellowship Grant, Grant Number: APP1035887.
Funding Information:
The work was funded by a National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (APP1041131). The views expressed in this study are solely those of the authors and do not reflect the views of the NHMRC. LKDL is a recipient of a CREMSI and Deakin University Post Graduate Scholarship. CM was funded by a NHMRC Early Career Fellowship Grant (APP1035887) during the conduct of this work. The authors acknowledge the contribution of the late A/Prof Jan Barendregt who provided supervision for L.K-D.L in the development of the model used in this study. We would like to thank Dr Holly Erskine (University of Queensland) for providing GBD 2013 data input.
Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2017/12
Y1 - 2017/12
N2 - Objective: This study was to model the cost-effectiveness of specialist-delivered cognitive behavioral therapy for bulimia nervosa (CBT-BN) compared to no intervention within the Australian context. Method: An illness-death model was developed to estimate the cost per disability-adjusted life-year (DALY) averted of CBT-BN over 2 years from the healthcare perspective. Target population was adults aged 18–65 years with BN. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. Uncertainty and sensitivity analyses were conducted to test the robustness of results. Results: Primary analysis indicated that CBT-BN was associated with greater DALY averted (0.10 DALY per person) and higher costs ($1,435 per person) than no intervention, resulting the mean ICER of $14,451 per DALY averted (95% uncertainty interval [UI]: $8,762 to $35,650). Uncertainty analysis indicated CBT-BN is 99% likely to be cost-effective at a threshold of $50,000 per DALY averted. Including the patients' time and travel costs resulted in the mean ICER of $18,858 per DALY averted (95% UI: $11,235 to $46,026). Sensitivity analysis indicated the intervention was not cost-effective if over 80% people discontinued treatment. Other analyses including a reduced time horizon, increased remission rates, and 4-month effect size of CBT-BN increases the ICERs but these ICERs remained well below under a threshold of $50,000 per DALY averted. Conclusion: This study has demonstrated that CBT-BN for adults with BN is a cost-effective treatment intervention. Further research is required to investigate the practicability of CBT-ED and the cost-effectiveness of other formats of CBT-BN delivery.
AB - Objective: This study was to model the cost-effectiveness of specialist-delivered cognitive behavioral therapy for bulimia nervosa (CBT-BN) compared to no intervention within the Australian context. Method: An illness-death model was developed to estimate the cost per disability-adjusted life-year (DALY) averted of CBT-BN over 2 years from the healthcare perspective. Target population was adults aged 18–65 years with BN. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. Uncertainty and sensitivity analyses were conducted to test the robustness of results. Results: Primary analysis indicated that CBT-BN was associated with greater DALY averted (0.10 DALY per person) and higher costs ($1,435 per person) than no intervention, resulting the mean ICER of $14,451 per DALY averted (95% uncertainty interval [UI]: $8,762 to $35,650). Uncertainty analysis indicated CBT-BN is 99% likely to be cost-effective at a threshold of $50,000 per DALY averted. Including the patients' time and travel costs resulted in the mean ICER of $18,858 per DALY averted (95% UI: $11,235 to $46,026). Sensitivity analysis indicated the intervention was not cost-effective if over 80% people discontinued treatment. Other analyses including a reduced time horizon, increased remission rates, and 4-month effect size of CBT-BN increases the ICERs but these ICERs remained well below under a threshold of $50,000 per DALY averted. Conclusion: This study has demonstrated that CBT-BN for adults with BN is a cost-effective treatment intervention. Further research is required to investigate the practicability of CBT-ED and the cost-effectiveness of other formats of CBT-BN delivery.
KW - bulimia nervosa
KW - cognitive behavioral therapy
KW - cost effectiveness
KW - economic evaluation
KW - health economics
UR - https://www.scopus.com/pages/publications/85037378609
U2 - 10.1002/eat.22790
DO - 10.1002/eat.22790
M3 - Article
C2 - 29044626
AN - SCOPUS:85037378609
SN - 0276-3478
VL - 50
SP - 1367
EP - 1377
JO - International Journal of Eating Disorders
JF - International Journal of Eating Disorders
IS - 12
ER -
SDG 3 Good Health and Well-being