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A Cost Effectiveness Analysis of Stepped Care Treatment for Bulimia Nervosa

Date Published: 11/12


Background: The cost effectiveness of various treatment strategies for bulimia nervosa (BN) is unknown. Aims: To examine the cost effectiveness of stepped care treatment for BN.

Method: Randomized trial conducted at four clinical centers with intensive measurement of direct medical costs and repeated measurement of subject quality of life and family/significant other time involvement. Two hundred ninety-three women who met DSM-IV criteria for BN received stepped care treatment or cognitive behavioral therapy. Cost effectiveness ratios were compared.

Results: The cost per abstinent subject was $12,146 for stepped care, and $20,317 for cognitive behavioral therapy. Quality of life ratings improved significantly with treatment, and family/significant other time burden diminished substantially.

Discussion: In this trial, stepped care for BN appeared cost effective in comparison to cognitive behavioral therapy. Treatment was associated with improved quality of life and diminished time costs of illness. VVC 2013 by Wiley Periodicals, Inc.

Scott J. Crow, MD1*
W. Stewart Agras, MD2
Katherine A. Halmi., MD3
Christopher G. Fairburn, MD4
James E. Mitchell, MD5
John A. Nyman, PhD6

*Correspondence to: Scott J. Crow, MD, Department of Psychiatry, University of Minnesota Medical School, 2450 Riverside Avenue, Minneapolis, MN 55454-1495.
1 Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota
2 Stanford University School of Medicine, Palo Alto, California
3 Department of Psychiatry, Weil Cornell Medical College, White Plains, New York
4 Department of Psychiatry, Oxford University, United Kingdom
5 Neuropsychiatric Research Institute, Fargo, North Dakota
6 Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota

Download Full Paper: PDF (182kb)

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