Cost-effectiveness of specialist eating disorders services for children and adolescents with anorexia nervosa: a national surveillance study.
Published version
Peer-reviewed
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Repository DOI
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Authors
Petkova, Hristina
Barrett, Barbara
Nicholls, Dasha
Abstract
Background
Evidence suggests specialist eating disorders services for children and adolescents with anorexia nervosa have the potential to improve outcomes and reduce costs through reduced hospital admissions. This study aimed to evaluate the cost-effectiveness of assessment and diagnosis in community-based specialist child and adolescent mental health services (CAMHS) compared to generic CAMHS for children and adolescents with anorexia nervosa.Method
Observational, surveillance study of children and adolescents aged 8 to 17, in contact with community-based CAMHS in the UK or Republic of Ireland for a first episode of anorexia nervosa. Data were reported by clinicians at baseline, 6 and 12-months follow-up. Outcomes included the Children's Global Assessment Scale (CGAS) and percentage of median expected body mass for age and sex (%mBMI). Service use data included paediatric and psychiatric inpatient admissions, outpatient and day-patient attendances. A joint distribution of incremental mean costs and effects for each group was generated using bootstrapping to explore the probability that each service is the optimal choice, subject to a range of values a decision-maker might be willing to pay for outcome improvements. Uncertainty was explored using cost-effectiveness acceptability curves.Results
Two hundred ninety-eight children and adolescents met inclusion criteria. At 12-month follow-up, there were no significant differences in total costs or outcomes between specialist eating disorders services and generic CAMHS. However, adjustment for pre-specified baseline covariates resulted in observed differences favouring specialist services, due to significantly poorer clinical status of the specialist group at baseline. Cost-effectiveness analysis using CGAS suggests that the probability of assessment in a specialist service being cost-effective compared to generic CAMHS ranges from 90 to 50%, dependent on willingness to pay for improvements in outcome.Conclusions
Assessment in a specialist eating disorders service for children and adolescents with anorexia nervosa may have a higher probability of being cost-effective than assessment in generic CAMHS.Trial registration
ISRCTN12676087 . Date of registration 07/01/2014.Description
Keywords
Anorexia Nervosa, Cost-effectiveness Analysis, Child And Adolescent Mental Health Services, Specialist Eating Disorders Services
Journal Title
Journal of eating disorders
Conference Name
Journal ISSN
2050-2974
Volume Title
9
Publisher
Publisher DOI
Sponsorship
HSCNI Public Health Agency Research and Development Division (COM/4716/12)
Department of Health (11/1023/17)
Health Services and Delivery Research Programme (11/1023/17)
Department of Health (11/1023/17)
Health Services and Delivery Research Programme (11/1023/17)