Crow Scott J, Nyman John A
Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota 55454, USA.
Int J Eat Disord. 2004 Mar;35(2):155-60. doi: 10.1002/eat.10258.
Anorexia nervosa (AN) is an expensive-to-treat illness with a high mortality rate. Some health care systems have limited the amount of treatment provided for AN despite the lack of clearly documented efficacy for these limited-intensity approaches. One method that can inform decisions about AN treatment is cost-effectiveness analysis.
Cost-modeling analysis was used to estimate the incremental cost-effectiveness of AN treatment. Modeling was chosen given the lack of primary data on costs and outcomes in AN treatment. Data for age of onset, life expectancy, and disease-associated mortality were taken from the literature. The costs of treatment used in the analysis were those in use at the University of Minnesota.
Assuming an approach consisting of inpatient weight restoration, followed by treatment of gradually diminishing intensity (partial hospitalization, then outpatient psychotherapy plus medication management), incremental cost-effectiveness ratios were calculated and compared with a limited intensity, "usual care" model. These assumptions yielded a cost per year of life saved of 30,180 dollars.
Relative to many other medical interventions, the comprehensive treatment of AN appears to be quite cost-effective in terms of cost per year of life saved. Such data may have an impact on payer decisions and underscore the serious nature of AN.
神经性厌食症（AN）是一种治疗费用高昂且死亡率高的疾病。尽管这些低强度治疗方法的疗效缺乏明确记录，但一些医疗保健系统仍限制了为AN提供的治疗量。成本效益分析是一种可为AN治疗决策提供参考的方法。
采用成本建模分析来估计AN治疗的增量成本效益。鉴于缺乏AN治疗成本和结果的原始数据，故选择建模。发病年龄、预期寿命和疾病相关死亡率的数据来自文献。分析中使用的治疗成本是明尼苏达大学所采用的成本。
假设采用一种包括住院体重恢复，随后进行强度逐渐降低的治疗方法（部分住院治疗，然后是门诊心理治疗加药物管理），计算增量成本效益比，并与低强度“常规护理”模型进行比较。这些假设得出挽救每一年生命的成本为30,180美元。
相对于许多其他医学干预措施，就挽救每一年生命的成本而言，AN的综合治疗似乎具有相当高的成本效益。此类数据可能会影响支付方的决策，并凸显AN的严重性。
