Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study

• Published in: Health services and delivery research 2019-10, Vol.7 (37), p.1-78
• Main Authors: Byford, Sarah, Petkova, Hristina, Stuart, Ruth, Nicholls, Dasha, Simic, Mima, Ford, Tamsin, Macdonald, Geraldine, Gowers, Simon, Roberts, Sarah, Barrett, Barbara, Kelly, Jonathan, Kelly, Grace, Livingstone, Nuala, Joshi, Kandarp, Smith, Helen, Eisler, Ivan
• Format: Article
• Language: English
• Subjects: anorexia nervosa; capss; cost-effectiveness analysis; eating disorders; economic evaluation
• ISSN: 2050-4349; 2050-4357
• DOI: 10.3310/hsdr07370

Background: Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions. Objectives: The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services. Design: Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System. Setting: Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland. Participants: A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria. Interventions: Community-based specialist eating disorders services and generic CAMHS. Main outcome measures: Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months. Data sources: Data were collected by clinicians from clinical records. Results: Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for t