title: Determinants of direct and indirect costs in anorexia nervosa.
abstract: OBJECTIVE
  To estimate direct and indirect costs of anorexia nervosa (AN), and to identify cost determinants.
  
  
  METHODS
  In a subsample (n = 225) of the ANTOP trial (Anorexia Nervosa Treatment of OutPatients) health care utilization and productivity losses were assessed at baseline for the previous 3 months and monetarily valued. Included were females aged 18 years and older diagnosed with AN or subsyndromal AN, and a body mass index (BMI) between 15 and 18.5 kg/m(2) . To account for missing data multiple imputation was employed. Cost determinants were derived from generalized linear models with gamma distribution and log link function.
  
  
  RESULTS
  Mean 3-months costs per patient amounted to €5,866 (SE = €576). The largest share of costs (€3,374) resulted from hospitalizations. Determinants of direct costs were analyzed separately for those with hospitalizations for AN, and those without. In the group only treated as outpatients, participants with binge/purge subtype, and those diseased for more than 6 years had higher costs. Moreover, costs were increased in patients with a comorbid mental disorder. In the group with hospitalizations, direct costs increased with BMI. BMI was measured at the end of the observation period, indicating that longer duration of treatment yielded higher weight gain. Indirect costs were not significantly associated with any disease-related characteristic.
  
  
  CONCLUSIONS
  Costs resulting from health care utilization and productivity loss are substantial, although the sample studied had not received sufficient treatment. Future research should analyze the development of costs over time.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Stuhldreher
authors.forename: Beate
authors.initials: B
authors.lastname: Wild
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
authors.forename: Alexander
authors.initials: A
authors.lastname: Konnopka
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000191:economics* / Q000628:therapy; D003365:Costs and Cost Analysis / Q000379:methods; D005260:Female; D005858:Germany; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D012107:Research Design; D013997:Time Factors; D055815:Young Adult
keywords: anorexia nervosa; cost determinants; cost-of-illness; economics