Economic evidence for prevention and treatment of eating disorders: An updated systematic review

ObjectiveThis systematic review updates an existing review examining the cost-effectiveness of interventions to prevent and treat eating disorders (EDs).MethodLiterature search was conducted in Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite, and Health Policy Reference Center electronic databases, capturing studies published between March 2017 to April 2023. Hand-searching was conducted as supplementary including gray literature search. Included articles were (1) full economic evaluations or return-on-investment studies, (2) in English and (3) aimed at prevention and treatment of any ED. Included studies were added and synthesized with previously reviewed studies. Screening and extraction followed PRISMA guidelines. Quality assessment was conducted using the Drummond checklist. PROSPERO registration CRD42021287464.ResultsA total of 28 studies were identified, including 15 published after the previous review. There were nine prevention, seven anorexia nervosa (AN) treatment, five bulimia nervosa (BN) treatment, four binge-eating disorder (BED), and three non-specific ED treatment studies. Findings indicate value-for-money evidence supporting all interventions. Quality assessment showed studies were fair-to-good quality.DiscussionThere has been significant growth in cost-effectiveness studies over the last 5 years. Findings suggest that interventions to prevent and treat ED offer value for money. Interventions such as Featback (ED prevention and non-specific ED treatment); focal psychodynamic therapy, enhanced cognitive behavioral therapy, and high-calorie refeeding (AN treatment); stepped-care with assisted self-help and internet-based cognitive behavioral therapy (BN treatment); and cognitive behavioral therapy guided self-help intervention (BED treatment) have good quality economic evidence. Further research in implementation of interventions is required.Public Significance StatementThe increasing prevalence of ED globally has significant impact on healthcare systems, families, and society. This review is showcasing the value for money of interventions of eating disorders prevention and treatment. This review found that existing interventions offers positive economic benefit for the healthcare system. ObjetivoResultadosLa terapia cognitivo-conductual (TCC) es un tratamiento recomendado para los trastornos de la conducta alimentaria (TCA) en adultos debido a su evidencia, basada principalmente en estudios de eficacia. Sin embargo, se sabe poco sobre como funciona la TCC en la atencion clinica rutinaria. El objetivo de este meta-analisis es investigar como funciona la TCC para diversos TCA cuando se lleva a cabo en entornos clinicos habituales.MetodoSe realizo una busqueda sistematica en Ovid MEDLINE, Embase OVID y PsycINFO de articulos publicados hasta junio de 2023. Se examinaron el resultado de la TCC, la calidad metodologica, el riesgo de sesgo y los moderadores del resultado del tratamiento, y se compararon metaanaliticamente con estudios de eficacia para TCA. Se incluyeron cincuenta estudios que comprendian a 4299 participantes que recibieron TCC.Se obtuvieron tamanos del efecto (TE) grandes dentro del grupo para la patologia de los TCA en el post-tratamiento (1.12) y en el seguimiento (1.22), en promedio 9.9 meses despues del post-tratamiento. La tasa de abandono fue del 25.5% y el riesgo de sesgo fue considerable en la mayoria de los estudios. El analisis de comparacion mostro que los estudios de efectividad tenian TE muy similares a los estudios de eficacia (1.20 en el post-tratamiento y 1.28 en el seguimiento).ConclusionLa TCC para los TCA es un tratamiento efectivo cuando se administra en la atencion clinica rutinaria, con TE comparables a los encontrados en estudios de eficacia. Sin embargo, la evidencia debe interpretarse con cautela debido al riesgo de sesgo en una alta proporcion de los estudios.

Automated summary

This systematic review examines the cost-effectiveness of interventions to prevent and treat eating disorders. The findings indicate that all interventions offer value for money and have good quality economic evidence. However, further research is required to understand the implementation of these interventions.