Authors' objectives:

The aim of this review is to establish whether in-patient care is more clinically effective and cost effective than out-patient care in the treatment of eating disorders.

Authors' recommendations: The evidence from the single RCT with available data suggests that for the group of people with anorexia nervosa which is severe enough to consider in-patient care but not severe enough for this to be essential, out-patient treatment is at least as effective as inpatient treatment. Indeed, the findings are suggestive of better outcomes for the outpatient groups. The benefits of out-patient and in-patient treatment appear to increase over time. However, the size of the RCT means that none of these trends are proved. Outpatient treatment is also considerably cheaper.There are some further caveats to this conclusion:1. The RCT was not blinded and the difficulties in carrying it out means that the results must be viewed with caution.2. All patients had to be sufficiently ill that in-patient treatment was a possibility but not essential. Therefore, the findings only apply where it is difficult to decide whether a person should be treated as an in-patient or as an out-patient. Where a person is profoundly physically ill or has dire social circumstances directly affecting physical wellbeing, in-patient treatment remains the treatment of choice.3. The costs obtained from the RCT study group do not have precise details as to how they were collected. Therefore it is difficult to judge their accuracy. The evidence from the case series show a wide variety of mortality and percentage well outcomes. This means that drawing conclusions from these case series as a whole is not possible.Evidence from the case-control studies and audit suggest that, in normal practice, those admitted as in-patients have, on average, a lower weight than those not admitted. There are few other differences between those normally treated as in-patients compared to those normally treated as out-patients, particularly for psychological factors.It seems likely that the average duration of stay for those treated as in-patients has been gradually reducing over the last 10 years.The evidence on costs shows a wide variation in costs for in-patient and out-patient treatment. It is very difficult to establish how accurate any of these methods were but, whatever method was used, out-patient treatment always came out cheaper than in-patient treatment.The available evidence shows no statistically significant differences in findings on outcomes between in-patient and out-patient care for people with eating disorders. This means that we were unable to progress to an analysis of cost effectiveness. Much more research needs to be undertaken on both in-patient and out-patient care for people with eating disorders. The lack of sufficiently powered RCTs and of good quality case series of in-patients and out-patients suggests that this treatment area has not been sufficiently researched in the past. If more people are to be treated solely in an out-patient setting in the future, it is vital that the progress of these people is followed carefully, in order to confirm the suggested trends from the available research.

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/1999/eatingdisorder.pdf

Year Published: 1999

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham