Quantifying the economic value of earlier and enhanced management of anorexia nervosa for adults in England, Germany and Spain: improving the care pathway

Background 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. Methods 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. Results 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%. Conclusions 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.