The national economic burden of eating disorders in Wales: a clinical population data study

Abstract Background Eating disorders have the highest morbidity of all mental disorders in the UK and can require admission to hospital. We aimed to provide whole system quantification of inpatient admission and general practitioner (GP) contact costs to the National Health Service (NHS) for patients with eating disorders in Wales. Methods The Secure Anonymised Information Linkage (SAIL) databank contains 84% of all electronic data obtained by NHS Wales General Practices since 1990 and all NHS hospital admissions data for Wales recorded since 1998. We obtained data on hospital admissions between Jan 1, 1998, and June 30, 2017, and GP contacts between July 1, 1990, and June 30, 2017, for patients with eating disorders, diagnosed using International Classification of Diseases (ICD)-9 and ICD-10 codes or GP Read Codes in GP or inpatient records and for a matched control cohort. We calculated total costs of hospital admissions and GP contacts between 1990 and 2017, using published unit costs for these patients, irrespective of year of diagnosis. Findings Between July 1, 1990, and June 30, 2017, 15 558 individuals were diagnosed with eating disorders within SAIL. 4707 individuals had complete GP records for the 2 year period before and 3 year period after diagnosis and were matched to four controls each. 4222 individuals within the case cohort had a total of 35 849 admissions with total admission costs of £81 218 113 (£17 254 751 per 1000 individuals) over 20 years between Jan 1, 1998, and June 30, 2017. By contrast, in the control cohort, 13 419 individuals were admitted to hospital with a total cost of £39 305 793 (£2 089 845 per 1000 individuals) for the same 20-year period. The cost of GP contacts over 27 years between July 1, 1990, and June 30, 2017, was £177 406 330 (£37 689 894 per 1000 individuals) for the eating disorder cohort (n=4707) and £321 041 292 (£17 069 401 per 1000 individuals) for patients in the control group (n=18 808). Interpretation Eating disorders result in high costs to the NHS, particularly for hospital admissions. Therefore, greater investment in prompt recognition and early intervention for individuals with eating disorders, which greatly shorten duration of illness, are likely to be economically justifiable. Funding Health and Social Care Wales.