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Cost-effectiveness of Intervention Implementation Support for Reducing Eating Disorder Symptoms Among College Students

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Abstract

Implementation support for prevention interventions is receiving increased attention, as many organizations receive training in evidence-based practices but do not deliver the interventions optimally. The Body Project, a four-session program, significantly reduces eating disorder symptoms and future disorder onset among group participants when delivered by peer educators at colleges/universities. Costs and cost-effectiveness of the program were examined using data from a randomized trial that compared three levels of implementation support at 63 colleges: (1) a train-the-trainer (TTT) workshop alone, (2) TTT plus a technical assistance (TA) workshop, or (3) TTT plus TA plus monthly quality assurance (QA) consultations. Effectiveness was measured by the production of reliable change in eating disorder symptoms from pretest to posttest. Costs and cost-effectiveness of two levels of implementation support are reported, comparing TTT-only with TTT + TA + QA (effectiveness of the TTT + TA condition did not differ from TTT-only) and using results from an earlier study as a proxy for a no-treatment control. Two perspectives are considered: a sponsoring organization providing the training at multiple sites and a college delivering the intervention to its eligible students. From the perspective of a sponsoring organization, adding both the TA training and QA support improves the cost-effectiveness per eligible student receiving the intervention. From the perspective of costs for a college to deliver the intervention, receiving TA training and QA support is also more cost-effective than the training workshop alone, whether the peer educators are paid or unpaid and whether costs of group supervision are included or excluded. Results converge with previous research showing that more intensive implementation support can be more cost-effective.

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Acknowledgements

The authors would like to thank Lindsey Greenwaldt for her efforts in coordinating study data collection and for the information she provided to help with the cost inventories. They would also like to thank Jeff Gau for help with outcome data analysis.

Funding

This study was supported by grant # MH112743 from the National Institute of Mental Health, which played no role in the identification, design, conduct, and reporting of the analysis.

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Authors and Affiliations

  1. Oregon Research Institute, Eugene, OR, USA

    Laura Akers & Paul Rohde

  2. Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    Heather Shaw & Eric Stice

Authors
  1. Laura Akers
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  2. Paul Rohde
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  3. Heather Shaw
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  4. Eric Stice
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Contributions

Tasks completed by the authors are as follows: LA conducted the cost analysis, interpreted the findings, and lead the writing of the manuscript. PR, HS, and ES conceived and designed the study for which the cost analysis was conducted, supervised the data acquisition, and revised the manuscript for important intellectual content. All authors read and approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Laura Akers.

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Ethical Approval

All procedures performed in the study were in accordance with the ethical standards of the institutional research committee at Oregon Research Institute and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed written consent was obtained from all participants included in this study.

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The authors declare no competing interest.

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Akers, L., Rohde, P., Shaw, H. et al. Cost-effectiveness of Intervention Implementation Support for Reducing Eating Disorder Symptoms Among College Students. Prev Sci 25, 498–508 (2024). https://doi.org/10.1007/s11121-024-01653-2

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