School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
Int J Eat Disord. 2021 Jul;54(7):1224-1237. doi: 10.1002/eat.23554. Epub 2021 May 17.
Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH).
A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge-eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective.
Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p < .0001; IRR = -1.62 [95% CI -2.25, -1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day.
Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater.
提高进食障碍循证治疗的可及性是一个重要目标。本研究旨在探究面对面会议指导的自助治疗（fGSH）和更具扩展性的电子邮件支持自助治疗（eGSH）的有效性和成本效益。
在三个地点开展了一项实用的随机对照试验。患有暴食障碍的成年人被随机分配到 fGSH、eGSH 或等待名单组，每个组持续 12 周。临床有效性的主要结局变量是进食心理病理的总体严重程度，成本效益的主要结局变量是无暴食天数，还进行了症状戒除的探索性分析。从部分社会和医疗保健提供者的角度估计了成本。
每个组有 60 名参与者。与对照组相比，两种形式的 GSH 均能更有效地降低进食心理病理（IRR=-1.32[95%CI-1.77,-0.87]，p<0.0001；IRR=-1.62[95%CI-2.25,-1.00]，p<0.0001）和暴食。eGSH 的脱落率较高。与 WL 相比，fGSH 和 eGSH 的成本效益概率分别为 93%（99%）和 51%（79%），对于每增加一个无暴食天数的意愿支付额分别为 100 英镑（150 英镑）和 100 英镑（150 英镑）。
两种形式的 GSH 均与临床改善相关，与等待名单组相比，均具有成本效益。通过电子邮件提供支持可能对许多患者更方便，但不完成的风险更大。
