Healthcare use and costs of adults with anorexia nervosa and bulimia nervosa in Taiwan

Abstract

Objective: This study aimed to examine the health service use and healthcare costs of adults with anorexia nervosa (AN) and bulimia nervosa (BN) in Taiwan. Method: AN and BN cases between 2002-2013 were extracted from a national health insurance database. For each AN and BN case, we randomly selected 10 controls with no eating disorder, matched for sex, age, urbanization of residence, and year of medical visit. The percentage and frequency of health services use and costs in the year preceding and after the diagnosis of AN/BN were compared between groups. We used generalized linear models with gamma distribution and log link function to determine the effects of age, sex, and psychiatric comorbidities on the total cost adjusting for physical comorbidities and to calculate the mean cost difference between groups by using marginal and incremental effects. Results: Both individuals with AN and BN had significantly elevated healthcare utilization and costs compared to controls during the baseline and one-year period after diagnosis. Patients with AN had more than three times higher total costs (US $792) and patients with BN had two times higher total costs (US $320) than individuals without eating disorders. Comorbidity of depressive disorder and older age significantly increased healthcare costs among both individuals with AN and BN. Discussion: There are high medical and economic burdens of care for individuals with AN and BN. Early diagnosis and integrated care for eating disorders are important tasks to reduce disease burden in Taiwan.

Introduction to a special issue on eating disorders in Asia

“…They reported significantly elevated healthcare utilization and costs compared to controls during the baseline and one‐year period after diagnosis. The same group reported on the poor recognition of BN and the lack of a precise diagnosis of AN by psychiatrists, highlighting the necessity of educational programs that focus on advancing knowledge about the differential diagnosis and tailored management of different EDs in Taiwan (Tseng, Chao‐Ying, & Chang, 2021).…”

Cost-of-illness for Non-underweight Eating Disorders

“…A sensitivity analysis (where individuals with missing data were excluded) suggested a gure of £3325.38 (€3,824.19). Results should be considered indicative (rather than exact) and taken alongside those of other studies -such as appraisals obtained from health insurance databases (e.g., [7,15]) and other surveys (e.g., [5,38]) -to estimate the overall economic impact of the full range of EDs.…”

“…This group represents the majority of those residing in the community [8] and those presenting for outpatient treatment [9] but is often overlooked in cost-of-illness studies. Existing work has tended to focus on one particular illness rather than considering a range of ED presentations [1,7,[10][11][12][13], with studies of anorexia nervosa particularly common, and there has been limited exploration of factors associated with healthcare costs [7], which can help inform both healthcare and research priorities.…”

“…Healthcare usage for non-underweight individuals who report regular binge eating is higher than that for individuals without EDs (e.g., [12,14,15]), even when accounting for comorbidities (e.g., [7,16]). When examining economic impact, these studies have generally focused on healthcare costs, with annual estimates for BN in the range of €888 to €18,823, and €1762 to €2902 for individuals with BED [17], with societal costs seldom reported (cf.…”

“…Although some studies have looked at the in uence of demographic factors such as age and gender (e.g., [7,13]), few have explored whether common ED symptoms, such as binge eating, are associated with costs. Looking at a sample of women seeking treatment for regular binge eating, Dickerson et al [20] found that baseline binge eating frequency was not associated with costs, although age was positively related to both medication costs and total healthcare costs.…”