Health Economic Evaluation of Cognitive-Behavioral Therapy for Adolescents With Binge-Eating Disorder in Germany

To determine the cost-effectiveness of cognitive-behavioral therapy (CBT) for adolescents with binge-eating disorder (BED), focusing on the costs per binge-free episode and per quality-adjusted life year (QALY) gained in comparison to a waitlist (WL) control group.

In the prospective, randomized superiority Binge-Eating Disorder in Adolescents (BEDA) trial, evaluating the efficacy of CBT with 20 individual sessions over 4 months versus WL, clinical and cost data were assessed at baseline and after 4 months. Missing values were imputed using multiple imputation techniques. The incremental cost-effectiveness ratio (ICER) was calculated. To reflect uncertainty, nonparametric bootstrapping was performed, and the results were presented in the form of cost-effectiveness acceptability curves (CEACs).

The study population consisted of 73 adolescents (82.2% female, mean age: 15.5 ± 2.6 years). Participants receiving CBT (n = 37) exhibited 4.7 more binge-free episodes (p = 0.0056) than the WL group (n = 36). The ICER was €46.70 for the gain of a binge-free episode and €128,861 for the gain of a QALY.

The probability of cost-effectiveness for achieving a binge-free episode is > 95% at a willingness-to-pay of €101. In terms of QALYs, CBT for BED may be a cost-effective intervention. A longer follow-up period may have yielded more favorable cost-effectiveness results.

German Clinical Trials Register, https://www.drks.de, DRKS00000542.