New SickKids study examines cost of paediatric inpatient treatment for anorexia nervosa

Anorexia nervosa is the third most common chronic condition affecting adolescent females in Canada, with an incidence of about five per cent. Anorexia nervosa has a profound impact on the psychological and physical health of adolescents. However, the direct and indirect costs of anorexia nervosa have gone largely understudied. Researchers at The Hospital for Sick Children (SickKids) are the first to look at the cost of paediatric inpatient treatment for adolescents with anorexia nervosa from a hospital and caregiver perspective and to assess predictors of hospitalization costs in Canada. The study is published in the May 1 online edition of CMAJ Open.

Through a study of 73 adolescents, the team at SickKids found that the costs associated with anorexia nervosa to families and hospital are substantial – $55,000 per admission based on an average length of stay of 37.9 days at the time of the study. In addition to the direct hospital costs of inpatient treatment, caregivers and families of patients with eating disorders often describe the financial drain of the illness, referring to the indirect, hidden costs, such as transportation, food, additional family care costs and time missed from work.

“Recognizing eating disorder symptoms early may preclude the need for hospitalization or result in admissions at higher BMIs, which could translate into better patient outcomes,” says Dr. Alene Toulany, Staff Physician in Adolescent Medicine at SickKids and lead author of the study. “Our results suggest that from a societal perspective, the economic burden of hospitalization for anorexia nervosa is large. Inpatient care costs are the most expensive component of care for patients with eating disorders.”

The study examined a variety of factors including the patient age, sex, postal code of residence, presence and age of siblings, Body Mass Index (BMI), comorbidities, duration of anorexia nervosa symptoms, previous treatments, length of hospitalization and time spent on the wait list. BMI and age were the only significant predictors of costs. Lower BMI and younger age were associated with higher costs. One unit increase in BMI was associated with a 16 per cent decrease in hospital cost and 23 per cent decrease in caregiver cost. In addition, for every unit increase in age, there was a 14 per cent decrease in caregiver cost.

Early recognition and treatment of anorexia nervosa in adolescents may decrease the costs associated with hospitalization or even prevent the need for hospitalization altogether, says Toulany. Whether earlier admission for adolescents is cost-effective in the long-term when compared with outpatient family-based treatment has yet to be established, and will be a focus of future research.