Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK.
Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Eur Psychiatry. 2024 May 23;67(1):e43. doi: 10.1192/j.eurpsy.2024.1751.
Anorexia nervosa (AN) is a serious mental illness. One-third of people develop severe, enduring, illness, adversely impacting quality of life with high health system costs. This study assessed the economic case for enhanced care for adults newly diagnosed with AN.
A five-state 312-month-cycle Markov model assessed the economic impact of four enhanced care pathways for adults newly diagnosed with AN in England, Germany, and Spain. Enhancements were halving wait times for any outpatient care, receiving specialist outpatient treatment post-referral, additional transitional support post-referral, and all enhancements combined. Care pathways, estimates of impact, resource use, and costs were drawn from literature. Net monetary benefits (NMBs), impacts on health system costs, and disability-adjusted life years (DALYs) averted were estimated. Parameter uncertainty was addressed in multi-way sensitivity analyses. Costs are presented in 2020 purchasing power parity adjusted Euros.
All four enhanced care pathways were superior to usual care, with the combined intervention scenario having the greatest NMBs of €248,575, €259,909, and €258,167 per adult in England, Germany, and Spain, respectively. This represented maximum NMB gains of 9.38% (€21,316), 4.3% (€10,722), and 4.66% (€11,491) in England, Germany and Spain compared to current care. Healthcare costs would reduce by more than 50%.
Early and effective treatment can change the trajectory of AN. Reducing the untreated duration of the disorder is crucial. There is a good economic case in different country contexts for measures to reduce waiting times between diagnosis and treatment and increase access to enhanced outpatient treatment.
神经性厌食症（AN）是一种严重的精神疾病。三分之一的患者会发展为严重、持久的疾病，对生活质量产生不利影响，并导致高额的医疗系统成本。本研究评估了为新诊断为 AN 的成年人提供强化护理的经济案例。
一个五状态 312 个月周期的 Markov 模型评估了英国、德国和西班牙新诊断为 AN 的成年人的四种强化护理途径的经济影响。增强措施包括将任何门诊治疗的等待时间减半、在转诊后接受专科门诊治疗、在转诊后提供额外的过渡支持以及综合所有增强措施。护理途径、影响估计、资源使用和成本均来自文献。估计了净货币收益（NMB）、对医疗系统成本的影响以及避免的残疾调整生命年（DALY）。通过多向敏感性分析解决参数不确定性。成本以 2020 年购买力平价调整后的欧元呈现。
所有四种强化护理途径均优于常规护理，联合干预方案在英国、德国和西班牙的每个成年人的 NMB 分别为 248575 欧元、259909 欧元和 258167 欧元。这代表了与当前护理相比，英国、德国和西班牙的 NMB 最大收益分别为 9.38%（21316 欧元）、4.3%（10722 欧元）和 4.66%（11491 欧元）。与当前护理相比，医疗保健成本将减少 50%以上。
早期和有效的治疗可以改变 AN 的轨迹。减少疾病未治疗的持续时间至关重要。在不同的国家背景下，都有很好的经济学依据来采取措施减少诊断和治疗之间的等待时间，并增加获得强化门诊治疗的机会。
