Long-Term Outcomes of Guided Internet-Based Cognitive Behavioral Therapy for Anorexia Nervosa: 3-Year Follow-Up

Guided internet-based cognitive behavioral therapy (ICBT) provides an accessible alternative treatment for anorexia nervosa (AN), showing initial feasibility and effectiveness in the short term. However, limited research has explored its long-term outcomes in outpatient settings.

This study investigated the long-term outcomes and cost-effectiveness of guided ICBT in women with AN who were receiving outpatient treatment.

This study involved a 3-year follow-up of 11 adult women with AN who received guided ICBT in a previous trial. The Eating Disorder Examination Questionnaire (EDE-Q) and body mass index (BMI) were used as outcomes to assess the severity of AN. A repeated-measures ANOVA was conducted to assess differences in mean outcomes at baseline, post-intervention, and two follow-up time points. The incremental cost-effectiveness ratio was calculated to estimate the cost-effectiveness of this intervention, using quality-adjusted life years (QALYs), derived from the EuroQol 5 Dimension 5-Level (EQ-5D-5L), and costs from publicly available data from the Japanese healthcare system.

From baseline, EDE-Q global scores significantly decreased at the 1-year (d = -0.72) and 3-year follow-ups (d = -0.65), while BMI significantly increased at the 1-year (d = 0.66) and 3-year follow-ups (d = 0.98). The estimated incremental cost-effectiveness ratio was notably low, at approximately JPY 111,000 (US$725) per year.

These preliminary results suggest that guided ICBT may be effective in the long term for outpatients with AN. Since the threshold has been JPY 5 million in Japan, the current estimated incremental cost-effectiveness ratio suggests that providing guided ICBT to outpatients with AN is likely to be cost-effective.