Tuesday, July 1, 2008

Family Based Treatment is Cost-Effective for Adolescent AN

There's no way around it: anorexia (and other eating disorders) are difficult, expensive illnesses to treat. The good news is that effective treatments are available. Recovery can be a long, winding road (as I and other families know), but new research is showing the most effective ways to treat anorexia.

James Lock and his group out of Stanford University published an article in the latest issue of Eating Disorders: The Journal of Treatment and Prevention, titled "Costs of Remission and Recovery Using Family Therapy for Adolescent Anorexia Nervosa: A Descriptive Report." He looked at the costs to treat adolescents with AN and their families with a standard Family-Based Treatment approach.

The majority of the costs (72%), Lock found, were due to medical hospitalization, before or during outpatient treatment. Another 20% were due to outpatient psychiatric treatment, a much smaller percentage than is traditionally given. Noted Lock: "This result may be due to the specific outpatient management strategy used in this study which employed parents as the main agents for change. In cases where this approach is effective, this results in decreasing both the intensity of treatment as well as the need for other types of treatment such as individual, group, nutritional counselling, or other forms of treatment that would add expense."

Due to differences in insurance, the final costs listed in the paper did not factor in health coverage, or any deductibles and co-pays. The costs listed, then are the market cost of treatment and NOT what most people with insurance coverage would pay. Costs, however, would still be extensive. The study also failed to factor in food costs (which can be significant) and extraneous costs such as time off work for parents. Obviously, this would vary greatly from family to family, but again, these costs are significant.

Lock found that costs to recovery can vary widely, ranging from USD$33,000 for "partial remission," defined as weight >85% IBW, to USD$84,000 for full recovery (weight >95% IBW and Eating Disorder Examination scores in the normal range). This treatment is more expensive than that of even schizophrenia. But, considering that the average residential treatment stay lasts for 90 days, costs approximately USD$84,000 (often not covered by insurance), and lacks the scientific research and integrity of evidence based methods.

The Stanford group concluded that when "compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment."


marcella said...

While I can't argue with the validity of this research, I don't particularly like its message. In our part of the UK family based treatment for children and CBT for adults are the ONLY treatments available on the NHS unless you become extremely sick and/or have friends in high places. Families who struggle to make a success of the method (poor old James Lock is going to live to regret giving me that phrase to latch on to ;-) ) CAN feel as if they are being made to do the work that might better be done by professionals simply because the NHS doesn't have the money to spend on "proper" treatment. Just imagine if insurance companies decided it was the only treatment they would fund because it was the cheapest. Fine for those who do well, but for the sufferers themselves if their parents prove not to be up to the job, isn't it better to get someone who IS even if it costs a lot more to the insurance company.

mary said...

Even when it doesn't work at home it still makes the most sense to begin at home. We've known far too many who've had the advantage of having several trips to residential treatments and tons of outside support with family told to step back and yet with all this help the person who is sick seems to continue, deeply entrenched. Hospitals and residential treatment can give a family some relief but when it fails, which it often does, it can sometimes damage the parent child trust. It can leave a child feeling that they caused their ED and as you know it keeps many sufferers dwelling in the past rather than setting goals for a life without an ED.

I'm sorry that you're daughter and you went through so much Marcella. I wish that there was a way to bring in more close family and friends to help support in situations like your's. Things might have gone far worse had you not been as connected as you were. Somehow your home based treatment that frustrates you may be the path that has actually helped the most....however long it seems it went on.

marcella said...

Hi my friend

I'm not disagreeing that paying through the nose for non-evidence based treatments might have been worse, just a little worried about those insurance companies and NHS accountants taking what they want from the research and ignoring the rest.
I'm delighted to say that here in the UK Prof Janet Treasure and her team are doing some research into the costs (in terms of pounds and time etc) of eating disorders whatever the treatment modality and excited to have been asked to be part of it.

mary said...

I hear you. We need to see to it that illnesses are covered according to whatever is in the best interest of the patient. Life's too darn short to be messing around for years asking "are you ready yet?"
Makes me think of parents who ask a 3 yr. old if they are ready to go to bed. The answer is most often "no."
I'm sure you'll be able to contribute much to the study Marcella. Well, done at squeaking your wheels.