The Economic Burden of Patients with Eating Disorders to Healthcare Providers: A 27-Year Retrospective Record Linked Electronic Cohort Study

Abstract

Background: 70 million people worldwide suffer from an eating disorder (ED) and long-term care is often needed. Patients are often young and vulnerable yet ambivalent about recovery. Without specific knowledge of the disease trajectory, patients with ED can evade detection, delaying time to diagnosis and treatment, and influencing long-term outcome and grossly underestimating treatment costs. Aim: The aim of this study was to estimate the healthcare economic burden from 1990 to 2017 of a cohort of patients with a diagnosis of an ED. Methods: The linkage and hosting of data were performed in the Secure Anonymised Information Linkage (SAIL) databank using a retrospective cohort study design. The SAIL databank is a large routine clinical database covering Wales. The data used was from the Patient Episode Database for Wales, Wales Demographics Service and Welsh General Practice datasets between 01/07/1990 and 30/06/2017, which are placed in SAIL by the Welsh National Health Service (NHS) and other data holders. Findings: Between 1990 and 2017, 15,558 individuals had an ED diagnosis. Patients with ED had large costs for inpatient admissions and GP contacts. Interpretation: Routine clinical data can be used effectively to quantify some burden of costs of a mental disorder beyond service use. ED incurred high NHS costs for GP contacts and inpatient admissions. The study included patients across the spectrum of severities, irrespective of whether they are known to specialist services. The scale of costs suggest that suffering from ED is likely to cost the NHS in areas well beyond what specific mental health service provision costs. We suggest that it may be cost-effective to invest in early intervention services that can help patients recover promptly from ED and potentially prevent high long-term costs of treatment and debility. Funding: Health and Care Research Wales (Grant HRA-15-1079). Declaration of Interest: All the authors have no competing interests to declare. Ethical Approval: The study design uses anonymised data and therefore the need for ethical approval and participant consent was waived by the approving IRB (Institutional Review Board), the UK National Health Service Research Ethics Committee. Instead, the SAIL Information Governance Review Panel (IGRP), which contains members from the UK National Health Service Research Ethics Committee, experts in information governance and members of the public, approved the study, IGRP 0487. This study was carried out in Swansea University.