Objective
A number of effective treatments for bulimia nervosa have been developed, but they are infrequently used, in part due to problems with dissemination. The goal of this study was to examine the cost effectiveness of telemedicine delivery of cognitive behavioral therapy for bulimia nervosa.
Method
A randomized controlled trial of face-to-face versus telemedicine cognitive behavioral therapy for bulimia nervosa. One hundred twenty eight women with DSM-IV bulimia nervosa or eating disorder, not otherwise specified subsyndromal variants of bulimia nervosa were randomized to 20 sessions of treatment over 16 weeks. A cost effectiveness analysis from a societal perspective was conducted.
Results
The total cost per recovered (abstinent) subject was $9324.68 for face-to-face CBT, and $7300.40 for telemedicine CBT. The cost differential was accounted for largely by therapist travel costs. Sensitivity analyses examining therapy session costs, gasoline costs and telemedicine connection costs yielded fundamentally similar results.
Discussion
In this study, CBT delivered face-to-face and via telemedicine were similarly effective, and telemedicine delivery cost substantially less. These findings underscore the potential applicability of telemedicine approaches to eating disorder treatment and psychiatric treatment in general.
Bulimia nervosa (BN) is a common eating disorder (Hudson, Hiripi, Pope, & Kessler, 2006) which carries medical, social, and functional burdens (Crow & Peterson, 2003). A number of treatments have been developed which show some benefit, including cognitive behavioral therapy (CBT), interpersonal therapy and numerous pharmacotherapies (Shapiro et al., 2007). Psychotherapeutic treatments have generally shown better response rates than pharmacotherapies, but there are a number of strategic challenges in providing these therapies. It is uncommon for patients to receive these specific treatments from therapists trained in their use. This appears to be due to several factors, including the limited number of specialty centers for eating disorders; limited numbers of psychology training programs that include these treatments; and limited numbers of therapists who receive training in these treatments (Mussell et al., 2000). As a result, previous research suggests that individuals presenting for BN have usually not received an adequate trial of empirically supported psychotherapy for BN (Crow, Mussell, Peterson, Knopke, & Mitchell, 1999).
One option to consider to improve dissemination of these treatments is by strengthening training efforts. Another potential strategy is to provide such treatments via telemedicine. This approach has several potential benefits. First, it would make treatment from specialized eating disorder centers available in broad geographic areas. Second, it would allow for more efficient and specialized training and supervision of therapists. Finally, it is possible that treatment provided in this way could be more effective and less costly than alternatives (for example, compared to face-to-face therapy, there could be advantages in time and travel cost). Limited work to date examining costs in telepsychiatry suggests this may be true (Harley, 2006 and O'Reilly et al., 2007)
The goal of this analysis was to examine the cost effectiveness of CBT delivered via telemedicine versus face-to-face treatment with individuals with BN.
