A cost effectiveness analysis of stepped care treatment for bulimia nervosa

Scott J. Crow, W. Stewart Agras, Katherine A. Halmi., Christopher G. Fairburn, James E. Mitchell, John A. Nyman

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Background: The cost effectiveness of various treatment strategies for bulimia nervosa (BN) is unknown. Aims: To examine the cost effectiveness of stepped care treatment for BN. Method: Randomized trial conducted at four clinical centers with intensive measurement of direct medical costs and repeated measurement of subject quality of life and family/significant other time involvement. Two hundred ninety-three women who met DSM-IV criteria for BN received stepped care treatment or cognitive behavioral therapy. Cost effectiveness ratios were compared. Results: The cost per abstinent subject was 12,146 for stepped care, and 20,317 for cognitive behavioral therapy. Quality of life ratings improved significantly with treatment, and family/significant other time burden diminished substantially. Discussion: In this trial, stepped care for BN appeared cost effective in comparison to cognitive behavioral therapy. Treatment was associated with improved quality of life and diminished time costs of illness. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)

Original languageEnglish (US)
Pages (from-to)302-307
Number of pages6
JournalInternational Journal of Eating Disorders
Issue number4
StatePublished - May 2013


  • bulimia nervosa
  • cognitive behavioral therapy
  • cost effectiveness


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