Effectiveness and cost-effectiveness of cognitive behavior therapy-enhanced compared with treatment-as-usual for anorexia nervosa in an inpatient and outpatient routine setting: a consecutive cohort study

Background For anorexia nervosa, firm evidence of the superiority of specialized psychological treatments is limited and economic evaluations of such treatments in real world settings are scarce. This consecutive cohort study examined differential (cost-)effectiveness for adult inpatients and outpatients with anorexia nervosa, after implementing cognitive behavioral therapy-enhanced (CBT-E) throughout a routine setting. Methods Differences in remission, weight regain and direct eating disorder treatment costs were examined between one cohort (N = 75) receiving treatment-as-usual (TAU) between 2012–2014, and the other (N = 88) CBT-E between 2015–2017. The economic evaluation was performed from a health care perspective with a one-year time horizon, using EDE global score < 2.77, the absence of eating disorder behaviors combined with a BMI ≥ 18.5, as effect measure. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that CBT-E is cost effective compared to TAU. Results Using direct eating disorder treatment costs in the cost-effectiveness analysis, the cost-effectiveness plane of the base case scenario for all patients indicated a 84% likelihood of CBT-E generating better health gain at additional costs. The median ICER is €51,081, indicating a probable preference for CBT-E (> 50% probability of cost-effectiveness) assuming a WTP of €51,081 or more for each additional remission, On remission, no difference was found with 9.3% remission during TAU and 14.6% during CBT-E (p = .304). Weight regain was higher during CBT-E (EMD = 1.33 kg/m2, SE = .29, 95% CI [0.76–1.9], p < .001). Conclusions In this mixed inpatient and outpatient cohort study, findings indicate a probability of CBT-Ebeing more effective at higher costs. These findings may contribute to the knowledge of effectiveness and cost-effectiveness of specialized psychological treatments. Plain English Summary In this study, the effectiveness and treatment costs of a specialized psychological treatment for adult clients with anorexia nervosa were compared with a regular, non-specialist treatment. One group of inpatients and outpatients did receive non-specialist treatment, the next group of inpatients and outpatients received CBT-E, a specialized treatment, later on. CBT-E is recommended for clients with bulimia and with binge eating disorder, for clients with anorexia nervosa it is less clear which specialized psychological treatment should be recommended. Results indicate that at end-of-treatment, CBT-E was not superior on remission. When looking at weight regain, CBT-E seemed superior than the treatment offered earlier. Economic evaluation suggests that CBT-E generates better health gain, but at additional costs. This study contributes to the knowledge on the effectiveness and treatment costs of psychological treatments, as they are offered in routine practice, to adults with anorexia nervosa.

Efficacy of Liraglutide 3.0 Mg Treatment on Weight-Loss in Patients with Weight Regain After Bariatric Surgery

Purpose Bariatric surgery, as Roux-en-Y gastric bypass (RYGB), laparoscopic gastric banding (LGB) and laparoscopic sleeve gastrectomy (LSG), is considered the gold standard treatment to achieve long-term weight-loss in severe obesity. In patients who fail to maintain the achieved weight, pharmacological treatment may be required. Here, we reported our real-life experience on efficacy of liraglutide therapy in 62 patients who regained weight after bariatric surgery.MethodsWe retrospectively evaluated 62 (60 F-2 M; mean age: 43.6±9.9 years) patients received liraglutide for weight-loss after bariatric surgery (17 RYGB, 22 LGB and 23 LSG). Body mass index (BMI) before and after surgery was respectively of 45.4±5.5 kg/m2 and 29.5±4.9 kg/m2. Patients were followed from 2016 until 2021. Liraglutide was administered after weight regain once-daily subcutaneously at starting dose of 0.6 mg and with weekly increases up to 3.0 mg. Treatments were administered when a weight regain of 10-15% occurred after reaching a minimum weight-loss from bariatric surgery or if weight-loss after bariatric surgery was unsatisfactory. ResultsAfter a mean of 70.7±43.7 months from any bariatric surgery, all patients started liraglutide therapy. At this time, mean BMI was 34.2±4.8 kg/m2 (mean increased BMI: 4.7±2.8 kg/m2). After a mean of 10.5±4.4 months from the beginning of liraglutide, 9 patients achieved normal weight (BMI 24.1±0.9 kg/m2), 28 were overweight (BMI 26.9±1.6 kg/m2). Twenty patients achieved grade I (BMI 32.1±1.5 kg/m2), 5 grade II (BMI 37.3±2.0 kg/m2) obesity, none had grade III obesity (mean BMI change: -5.1±2.5 kg/m2). The treatment was well tolerated, and no serious adverse events were recorded.ConclusionThese data confirm the efficacy and safety of liraglutide in patients who experienced weight regain after bariatric surgery. Considering the long-term follow-up, patients should be followed up regularly and the pharmacological treatment should be adapted to the weight fluctuations observed during the clinical history.

Key Time Points After Bariatric Surgery, From Weight Loss To Weight Regain: Long-Term Retrospective Cohort Study

Background and Objective: Bariatric surgery may lead to an unsuccessful weight loss, weight loss plateau, and even weight regain in different time points after various types of surgery. Despite the numerous studies investigated bariatric surgery-induced weight loss, the long-term results of surgery, after repetitive weight fluctuations, is not really clear and remains as one of the most important concerns. The aim of the present study was to determine the key time points of weight changes after three types of bariatric surgery, and the estimation of five-year weight loss after surgery. Setting: This is a retrospective cohort study including patients with morbid obesity conducted in the obesity clinic of Minimally Invasive Surgery Research Center of Iran University of Medical Sciences. Methods The subjects underwent one of the three types of bariatric surgeries including laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) which had been followed up to five years after surgery. The percentage lost to follow-up was 34% until five-year after surgery. Results The mean %EWL a total of 2567 morbid obese participants (mean age=39.03, mean BMI=45.67) in the first six months after surgery was independent of the type of surgery. Ninth and 24th month after surgery were the times that OAGB and then RYGB induced weight loss sped up rather than LSG, respectively. Weight plateau and weight regain were initiated earlier (at 18th month) and more (18.23% of maximum EWL %) in LSG in the period of five years. The %EWL in time intervals of 3-6, 6-9, and 9-12 months after LSG, RYGB, and OAGB, respectively; could estimate the long-term five years %EWL after surgery. Conclusion OAGB provides the fastest and highest %EWL, and LSG induced the earliest and most weight plateau and weight regain during five years interval post-surgery. The pattern of early weight loss could predict the long-term outcome of bariatric surgery. So early identification of suboptimal weight loss could allow consideration of earlier postoperative intervention to enhance long-term weight loss.