title: The household economic burden of eating disorders and adherence to treatment in Australia.
abstract: BACKGROUND
  This study investigated the household economic burden of eating disorders and cost-related non-adherence to treatment in Australia.
  
  
  METHODS
  Multi-centre prospective observational study using a structured questionnaire. Ninety participants were recruited from two clinic settings in New South Wales, Australia and from the community using social media. The primary outcome measures were household economic burden of illness measured in terms of out-of-pocket expenditure, household economic hardship and cost-related non-adherence.
  
  
  RESULTS
  The pattern of out-of-pocket expenditure varied by diagnosis, with Bulimia Nervosa associated with the highest total mean expenditure (per three months). Economic hardship was reported in 96.7% of participants and 17.8% reported cost-related non-adherence. Those most likely to report cost-related non-adherence had a longer time since diagnosis. Cost-related non-adherence and higher out-of-pocket expenditure were associated with poorer quality of life, a more threatening perception of the impact of the illness and poor self-reported health.
  
  
  CONCLUSIONS
  This study is the first to empirically and quantitatively examine the household economic burden of eating disorders from the patient perspective. Results indicate that households experience a substantial burden associated with the treatment and management of an eating disorder. This burden may contribute to maintaining the illness for those who experience cost-related non-adherence and by negatively influencing health outcomes. Current initiatives to implement sustainable and integrated models of care for eating disorders should strive to minimise the economic impact of treatment on families.
authors.affiliation: The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. lauren.gatt@mq.edu.au.
authors.forename: Lauren
authors.initials: L
authors.lastname: Gatt
authors.affiliation: The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. sjan@georgeinstitute.org.au.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: Wesley Eating Disorder Centre, Wesley Hospital, Sydney, Australia. Naresh.Mondraty@wesleymission.org.au.
authors.forename: Naresh
authors.initials: N
authors.lastname: Mondraty
authors.affiliation: Eating Disorders Day Program, Royal Prince Alfred Hospital, Sydney, Australia. slhorsfield@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Horsfield
authors.affiliation: Eating Disorders Day Program, Royal Prince Alfred Hospital, Sydney, Australia. susan.hart@sswahs.nsw.gov.au.
authors.forename: Susan
authors.initials: S
authors.lastname: Hart
authors.affiliation: Eating Disorders Day Program, Royal Prince Alfred Hospital, Sydney, Australia. janice.russell@sydney.edu.au.
authors.forename: Janice
authors.initials: J
authors.lastname: Russell
authors.affiliation: The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. tlaba@georgeinstitute.org.au.
authors.forename: Tracey Lea
authors.initials: TL
authors.lastname: Laba
authors.affiliation: The George Institute for Global Health, University of Sydney, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia. beverley.essue@sydney.edu.au.
authors.forename: Beverley
authors.initials: B
authors.lastname: Essue
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D017281:Cost of Illness; D019468:Disease Management; D005191:Family Characteristics; D001068:Feeding and Eating Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult