Bulimia nervosa (BN) is a common eating disorder (Hudson, Hiripi, Pope, & Kessler, 2007) which carries medical, social, and functional burdens (Crow & Peterson, 2003). A number of treatments have been developed which show some benefit, including cognitive behavioral therapy (CBT), interpersonal therapy and numerous pharmacotherapies (Shapiro, et al., 2007). Psychotherapeutic treatments have generally shown better response rates than pharmacotherapies, but there are a number of strategic challenges in providing these therapies. It is uncommon for patients to receive these specific treatments from therapists trained in their use. This appears to be due to several factors, including the limited number of specialty centers for eating disorders; limited numbers of psychology training programs that include these treatments; and limited numbers of therapists who receive training in these treatments (Mussell, et al., 2000). As a result, previous research suggest that individuals presenting for BN have usually not received an adequate trial of empirically supported psychotherapy for BN (Crow, Mussell, Peterson, Knopke, & Mitchell, 1999).
One option to consider to improve dissemination of these treatment is by strengthening training efforts. Another potential strategy is to provide such treatments via telemedicine. This approach has several potential benefits. First, it would make treatment from specialized eating disorder centers available in broad geographic areas. Second, it would allow for more efficient and specialized training and supervision of therapists. Finally, it is possible that treatment provided in this way could be more effective and less costly than alternatives (for example, compared to face-to-face therapy, there could advantages in time and travel cost). Limited work to date examining costs in telepsychiatry suggests this may be true (Harley, 2006; O'Reilly, et al., 2007)
The goal of this analysis was to examine the cost effectiveness of CBT delivered via telemedicine versus face-to-face treatment with individuals with BN.