Comparing Stepped Care and CBT for Bulimia Nervosa

Stepped-care treatment is much more cost-effective than is cognitive behavior therapy (CBT) for patients with bulimia nervosa (BN), according to the results of a multi-center study (Int J Eat Disord. 2013 Jan 28; [epub ahead of print]). Dr. Scott Crow, of the University of Minnesota School of Medicine, Minneapolis, and colleagues at four clinical centers recently conducted a randomized trial comparing the two approaches. Two-hundred and  ninety three women who met DSM-IV criteria for BN received either stepped-care treatment or CBT. Researchers at the four treatment centers then carefully measured direct medical costs and assessed the subjects’ quality of life and family/significant other involvement. The cost ratios were then compared.

The mean cost per subject after successful treatment differed markedly in the two groups. The cost per patient was $20,317 for those treated with CBT, but $12,146 for those treated with a stepped-care approach. The subjects’ quality of life ratings improved significantly with treatment and family/significant other time burden lessened substantially with the stepped-care approach.