Analyzing the Cost of Inpatient Treatment for Anorexia Nervosa

A recent Canadian study sheds light on inpatient treatment costs for AN, as well as on caregiver and societal costs.

Reprinted from Eating Disorders Review
November/December Volume 26, Number 6
©2015 IAEDP

Inpatient treatment is the choice for medically unstable teens with anorexia nervosa (AN). However, one downside is that such stays can be both lengthy and costly. Hospitalization can have an impact on normal adolescent development, and interfere with academic and social functioning. Parents and caregivers face high levels of psychological and financial stress. 

Noting that the economic impact of eating disorders is great but still under-researched, Alene Toulany, MD, and colleagues at the University of Toronto designed a cohort study involving all adolescent patients aged 12 to 18 who were admitted for treatment of AN at a tertiary child and adolescent eating disorder program in Toronto between September 1, 2011 and March 31, 2013 (CMAJ Open. 2015. doi:10.97778/cmajo.20140086; published online). 

Data collected from 73 teens were included in this study. The researchers collected data on patient age, sex, place of residence, presence and age of siblings, patient body mass index (BMI, kg/m2), comorbidities, duration of AN symptoms, prior treatment for AN, length of hospital stay, and time spent on the wait list for admission. In addition, the team estimated caregiver costs associated with hospital visits. 

Most of the teens (89%) were females, and the mean age was 15.2 years. The mean BMI of the 73 participants was 16.1 (range: 11.3 to 26.2 kg/m2). Most of the patients were either admitted to the inpatient unit directly from the hospital's emergency department or from a unit at another hospital. Thirty percent had at least 1 comorbid medical diagnosis and 34% had at least one comorbid psychiatric diagnosis at admission. The mean length of time patients stayed in the hospital was 37.9 days, and hospitalization ranged from 9 to 153 days. 

Based on the mean hospital stay of 37.9 days the authors estimated the hospital, caregiver, and total societal costs (in Canadian dollars) at $1450 per admission day ($355 hospital, $95 caregiver, respectively).

The significance of admission BMI

The patient's BMI at admission was the only individually significant predictor of hospital costs, according to Dr. Toulany. For every unit increase in BMI, the authors found a 15.7% decrease in mean total hospital cost, after controlling for wait time between referral and start of inpatient treatment. In a second model that included previous AN treatments and comorbid medical conditions, BMI was once more the only significant predictor of costs.

From a societal perspective, the cost of hospitalization for AN was a mean of $54,932 (in Canadian dollars). The societal perspective is less commonly used in such analyses than the third party payor perspective (which only counts medical costs, not family and patient costs). Using the societal perspective is a strength of this study, as it provides fallen picture of costs reported here fall within the range described previously.

An important implication of this study is that finding cases earlier, and initiating treatment earlier in the course of weight loss, appear to diminish costs. This seems to make a strong case for aggressive early treatment.