Introduction
Eating disorders (EDs) are serious mental illnesses with multifactorial pathogenesis and biological, psychic, family, and sociocultural aspects. EDs are difficult-to-treat disorders that usually require strong therapeutic efforts implying high costs. The highest direct costs – in ED, as in mental health in general – are due to hospitalization. In Italy these costs are estimated on the bases of the Diagnosis Related Groups (DRG): 25 homogeneous groups of diagnoses with the same average production cost and the same refunding amount. Such a system does not reflect real costs and it does not enhance effectiveness of treatments. A good alternative to DRG could be an effective cost-benefit analysis.
Objectives
This study aimed to: a) quantify effective costs of ED hospitalization and determine if DRG refunds are appropriate – referring to estimates of the Piedmont Region; b) structure an analysis of cost-effectiveness using an assessment performed with QALYs (Quality Adjusted Life Years, i.e. 1 QALY = 1 year in good health); c) determine if the cost of an hospitalization is adequate, as related to clinical progress and inpatient outcome.
Methods
The sample comprised 101 women with a severe ED diagnosis, hospitalized at the Psychiatry ward of Turin University ED Center between Jan 1st, 2006 and Jan 1st, 2008. Both at admission and discharge, patients were assessed with a version of the EQ-5D (EUROQOL) that has been modified using the CGI to determine the cost-quality ratio of the intervention and to calculate the variation in QALYs. The after-discharge course was assessed after 6 months on the basis of tests, symptomatology and Body Mass Index (BMI).
Results
The average cost per day multiplied by the average days of hospitalization (23.68) resulted in the cost of an average hospitalization, i.e., €9,235. Currently hospitalizations for anorexia nervosa are refunded with €2,231.85 and for bulimia nervosa with €1,959.64. At discharge was observed an average increase of 0.2 QALYs; a good outcome at the 6-month follow-up correlated with a higher increase in QALYs (Table I). QALYs at discharge indeed were associated with different therapeutic interventions after discharge.
Conclusions
The analysis of the value for money could represent an appropriate instrument to monetize inpatient interventions. This is already adopted by several Countries like UK, New Zealand, Australia, Sweden, etc. Hospitalizations in ED are advantageous, because on the average they show a statistically significant improvement of QALYs: unfortunately, the difference between the effective cost of hospitalization and the one of DRG is on average €7,300 per hospitalization. The DRG weight, calculated in ED hospitalizations (around 0.7), explains this difference: hospitalization for EDs indeed is considered to need the same resources as hospitalization for bronchitis (0.74 points) or for routine appendicectomy (0.72 points). The modified EQ-5D and the assessment with QALYs proved to be useful instruments in evaluating hospitalization also according to a predictive perspective. Clinical and economical implications are also discussed