Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons.

Treatment guidelines state that cognitive-behavioral therapy (CBT) and interpersonal therapy are the best-supported psychotherapies for bulimia nervosa (BN) and that CBT is the preferred psychological treatment for binge eating disorder (BED). However, no meta-analysis which both examined direct comparisons between psychological treatments for BN and BED and considered the role of moderating variables, such as the degree to which psychotherapy was bona fide, has previously been conducted Thus, such an analysis was undertaken. We included 77 comparisons reported in 53 studies. The results indicated that: (a) bona fide therapies outperformed non-bona fide treatments, (b) bona fide CBT outperformed bona fide non-CBT interventions by a statistically significant margin (only approaching statistical significance for BN and BED when examined individually), but many of these trials had confounds which limited their internal validity, (c) full CBT treatments offered no benefit over their components, and (d) the distribution of effect size differences between bona fide CBT treatments was homogeneously distributed around zero. These findings provide little support for treatment specificity in psychotherapy for BN and BED.

Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span.

CONTEXT: The polycystic ovary syndrome (PCOS) is the most common endocrine abnormality of reproductive-aged women today, affecting approximately 6.6% of unselected reproductive-aged women (approximately 4 million women in the United States) (1990 National Institutes of Health criteria), and potentially represents a significant financial burden to our health care. OBJECTIVE: The objective of the study was to define, using current definitions and prevalence or incidence data, the minimal economic burden that PCOS in reproductive-aged women represents for the United States. DESIGN: The study design was a literature review. SETTING: The study was conducted at a tertiary care center. PATIENTS OR OTHER PARTICIPANTS: There were no patients or other participants. INTERVENTION(S): We performed a systematic review of the published medical literature to identify studies evaluating epidemiology of reproductive-age PCOS and its clinical consequences and costs. We tied general societal cost data for the different health consequences to reproductive-age PCOS costs, using prevalence data. MAIN OUTCOME MEASURE(S): The main measure in the study was total health care-related economic costs. RESULTS: We estimated the mean annual cost of the initial evaluation to be dollar 93 million (2.1% of total costs), that of hormonally treating menstrual dysfunction/abnormal uterine bleeding to be dollar 1.35 billion (31.0% of total), that of providing infertility care to be dollar 533 million (12.2% of total), that of PCOS-associated diabetes to be dollar 1.77 billion (40.5% of total), and that of treating hirsutism to be dollar 622 million (14.2% of total). CONCLUSIONS: The total cost of evaluating and providing care to reproductive-aged PCOS women in the United States is dollar 4.36 billion. Because the cost of the diagnostic evaluation accounted for a relatively minor part of the total costs (approximately 2%), more widespread and liberal screening for the disorder appears be a cost-effective strategy, leading to earlier diagnosis and intervention and possibly the amelioration and prevention of serious sequelae.