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Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents

  • Sarah Byford (a1), Barbara Barrett (a1), Chris Roberts (a2), Andrew Clark (a3), Vanessa Edwards (a4), Nicola Smethurst (a5) and Simon G. Gowers (a5)...



Young people with anorexia nervosa are often admitted to hospital for treatment. As well as being disruptive to school, family and social life, in-patient treatment is expensive, yet cost-effectiveness evidence is lacking.


Cost-effectiveness analysis of three treatment strategies for adolescents with anorexia nervosa.


UK multicentre randomised, controlled trial comparing in-patient psychiatric treatment, specialist out-patient treatment and general out-patient treatment. Outcomes and costs assessed at baseline, 1 and 2 years.


There were 167 young people in the trial. There were no statistically significant differences in clinical outcome between the three groups at 2 years. The specialist out-patient group was less costly over the 2-year follow-up (mean total cost £26 738) than the in-patient (£34 531) and general out-patient treatment (£40 794) groups, but this result was not statistically significant. Exploration of the uncertainty associated with the costs and effects of the three treatments suggests that specialist out-patient treatment has the highest probability of being cost-effective.


On the basis of cost-effectiveness, these results support the provision of specialist out-patient services for adolescents with anorexia nervosa.


Corresponding author

Sarah Byford, Box No 24, Centre for the Economics of Mental Health, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email:


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See pp. 427–435, this issue.

Declaration of interest


Funding detailed in Acknowledgements.



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Barber, J. A. & Thompson, S. G. (1998) Analysis and interpretation of cost data in randomised control trials: review of published studies. BMJ, 317, 11952000.
Barrett, B., Byford, S., Chitsabesan, P., et al (2006) Mental health provision for young offenders: service use and cost. British Journal of Psychiatry, 188, 541546.
Berridge, D., Beecham, J., Brodie, I., et al (2002) Costs and Consequences of Services for Troubled Adolescents: an Exploratory, Analytic Study (Department of Health Report). University of Luton.
British Medical Association & Royal Pharmaceutical Society of Great Britain (2004) British National Formulary 48. BMJ Books & Pharmaceutical Press.
Byford, S., Harrington, R., Torgerson, D., et al (1999) Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves. Results of a randomised controlled trial. British Journal Psychiatry, 174, 5662.
Crow, S. J. & Nyman, J. A. (2004) The cost-effectiveness of anorexia nervosa treatment. International Journal of Eating Disorders, 35, 155160.
Curtis, L. & Netten, A. (2004) Unit Costs of Health and Social Care. Personal Social Services Research Unit.
Department of Health (2004) NHSReference Costs. Department of Health.
Efron, B. & Tibshirani, R. J. (1993) An Introduction to the Bootstrap. Chapman & Hall.
Fenwick, E. & Byford, S. (2005) Aguidetocost-effectiveness acceptability curves. British Journal of Psychiatry, 187, 106108.
Fenwick, E., Claxton, K. & Sculpher, M. (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Economics, 10, 779787.
Gowers, S. G. (2006) Evidence based research in CBT with adolescent eating disorders. Childand Adolescent Mental Health, 11, 912.
Gowers, S. & Smyth, B. (2004) The impact of a Motivational Assessment Interview on intitial response to treatment in adolescent anorexia nervosa. European Eating Disorders Review, 12, 8793.
Gowers, S. G., Clark, A., Roberts, C., et al (2007) Clinical effectiveness of treatments for anorexia nervosa in adolescents. Randomised controlled trial. British Journal of Psychiatry, 191, 427435.
Green, J., Jacobs, B., Beecham, J., et al (2007) Inpatient treatment in child and adolescent psychiatry – an exploratory prospective study of health gain and costs. Journal of Child Psychology and Psychiatry, in press.
Harrington, R., Peters, S., Green, J., et al (2000) Randomised comparison of the effectiveness and costs of community and hospital based mental health services for children with behavioural disorders. BMJ, 321, 10471050.
Independent Schools Council (2004) Annual Census 2004. Independent Schools Council.
Johannesson, M. & Weinstein, M. C. (1993) On the decision rules of cost-effectiveness analysis. Journal of Health Economics, 12, 459467.
Morgan, H. G. & Hayward, A. E. (1988) Clinical assessment of anorexia nervosa. The Morgan–Russell outcome assessment schedule. British Journal of Psychiatry, 152, 367372.
National Collaborating Centre for Mental Health (2004) Core Interventions in the Treatment and Management of Anorexia Nervosa and Related Eating Disorders. British Psychological Society & Gaskell.
National Institute for Clinical Excellence (2004) Guide to the Methods of Technology Appraisals. NICE.
Romeo, R., Byford, S. & Knapp, M. (2005) Economic evaluations of child and adolescent mental health interventions: a systematic review. Journal of Child Psychology and Psychiatry, 46, 919930.
Romeo, R., Knapp, M. & Scott, S. (2006) Economic cost of severe antisocial behaviour in children – and who pays it. British Journal of Psychiatry, 188, 547553.
Simon, J., Schmidt, U. & Pilling, S. (2005) The health service use and cost of eating disorders. Psychological Medicine, 35, 15431551.
Striegel-Moore, R. H., Leslie, D., Petrill, S. A., et al (2000) One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. International Journal of Eating Disorders, 27, 381389.
Van Hout, B. A., Al, M. J., Gordon, G. S., et al (1994) Costs, effects and c/e-ratios alongside a clinical trial. Health Economics, 3, 309319.
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Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents

  • Sarah Byford (a1), Barbara Barrett (a1), Chris Roberts (a2), Andrew Clark (a3), Vanessa Edwards (a4), Nicola Smethurst (a5) and Simon G. Gowers (a5)...
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