Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2015; 5(1): 147-153
Published online Mar 22, 2015. doi: 10.5498/wjp.v5.i1.147
Systematic review of evidence for different treatment settings in anorexia nervosa
Sloane Madden, Phillipa Hay, Stephen Touyz
Sloane Madden, Department of Psychological Medicine, Sydney Children’s Hospital Network, Westmead NSW 2145, Australia
Sloane Madden, Faculty of Medicine, University of Sydney, Sydney NSW 2006, Australia
Phillipa Hay, Centre for Health Research, School of Medicine, University of Western Sydney, Campbelltown, Parramatta NSW 2150, New South Wales, Australia
Phillipa Hay, School of Medicine, James Cook University, Townsville, Queensland 4810, Australia
Stephen Touyz, School of Psychology and Centre for Eating and Dieting Disorders, University of Sydney, Sydney NSW 2006, Australia
Author contributions: Madden S and Hay P contributed to the identification of trials and data extraction; Madden S wrote the manuscript; Madden S, Hay P and Touyz S designed the review, interpreted the results and edited the manuscript.
Supported by The authors are also authors on one included paper (Madden S et al, 2014). Madden S and Touyz S have received consultancy fees from Shire Pharmaceuticals.
Data sharing: The article is not a basic research or clinical research study so has no data to share.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Sloane Madden, MBBS (Hons), Department of Psychological Medicine, Sydney Children’s Hospital Network, Westmead Campus, Locked Bag 4001, Westmead NSW 2145, Australia. sloane.madden@health.nsw.gov.au
Telephone: +61-2-98452005 Fax: +61-2-98452009
Received: December 2, 2014
Peer-review started: December 4, 2014
First decision: January 20, 2015
Revised: January 28, 2015
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: March 22, 2015
Abstract

AIM: To compare outcomes in anorexia nervosa (AN) in different treatment settings: inpatient, partial hospitalization and outpatient.

METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms “anorexia nervosa” and “treatment” dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors (Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition.

RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care.

CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.

Keywords: Anorexia nervosa, Treatment, Inpatient, Outpatient, Day patient

Core tip: Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. This study compared outcomes in AN treatment studies comparing different treatment settings: inpatient, day-patient and outpatient. Five studies were identified. There was no difference in outcomes between the different settings and lengths of inpatient treatment. Both outpatient and day-patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was cheaper than prolonged inpatient care for weight normalization. There is support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting.