Abstract
BackgroundThis study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia.MethodsMulti-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence.ResultsThe pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health.ConclusionsThis study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0338-0) contains supplementary material, which is available to authorized users.
Highlights
This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia
Ninety participants completed questionnaires. 54.4% of participants had a self-reported diagnosis of Anorexia Nervosa (AN), either purging or restricting subtype, 16.7% had a diagnosis of Bulimia Nervosa (BN) and 28.9% were diagnosed as either Binge Eating Disorder, Eating Disorder Not Otherwise Specified or did not know their diagnosis (Other hereafter) (Table 1)
Participants recruited from Wesley Hospital were more likely to have the following characteristics: a diagnosis of AN, a hospital admission in the previous 12 months, qualified for the Medicare or Pharmaceutical Benefits Scheme safety net programs at the time of the interview, private health insurance and were less likely to be in paid employment
Summary
This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia. Lack of drug coverage has been found to strongly inhibit prescription drug use, even in Australia where most essential medications for chronic illnesses are heavily subsidized through a national health insurance system, Medicare [11,12,13]. Such as scheme covers, with a patient copayment, the cost of listed medicines (through the Pharmaceutical Benefits Scheme (PBS)) and medical services (through the Medical Benefit Scheme (MBS)). Exemption from copayments is available when individuals hit a certain ‘safety net’ threshold, which is a defined level of expenditure per calendar year (in 2014, the PBS threshold is $1421 per year for general beneficiaries and $360 per year low income concession card holders; for MBS it is $1248 and $624 respectively per year)
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