title: Cost analysis of inpatient treatment of anorexia nervosa in adolescents: hospital and caregiver perspectives.
abstract: BACKGROUND
  Admission to hospital is the treatment of choice for anorexia nervosa in adolescent patients who are medically unstable; however, stays are often prolonged and frequently disrupt normal adolescent development, family functioning, school and work productivity. We sought to determine the costs of inpatient treatment in this population from a hospital and caregiver perspective, and to identify determinants of such costs.
  
  
  METHODS
  We used micro-costing methods for this cohort study involving all adolescent patients (age 12-18 yr) admitted for treatment of anorexia nervosa at a tertiary care child and adolescent eating disorder program in Toronto, between Sept. 1, 2011, and Mar. 31, 2013. We used hospital administrative data and Canadian census data to calculate hospital and caregiver costs.
  
  
  RESULTS
  We included 73 adolescents in our cohort for cost-analysis. We determined a mean total hospital cost in 2013 Canadian dollars of $51 349 (standard deviation [SD] $26 598) and a mean total societal cost of $54 932 (SD $27 864) per admission, based on a mean length of stay of 37.9 days (SD 19.7 d). We found patient body mass index (BMI) to be the only significant negative predictor of hospital cost (p < 0.001). For every unit increase in BMI, we saw a 15.7% decrease in hospital cost. In addition, we found higher BMI (p < 0.001) and younger age (p < 0.05) to be significant negative predictors of caregiver costs.
  
  
  CONCLUSIONS
  The economic burden of inpatient treatment for adolescents with anorexia nervosa on hospitals and caregivers is substantial, especially among younger patients and those with lower BMI. Recognizing the symptoms of eating disorders early may preclude the need for admission to hospital altogether or result in admissions at higher BMIs, thereby potentially reducing these costs.
authors.affiliation: Division of Adolescent Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ont. ; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. ; University of Toronto, Toronto, Ont.
authors.forename: Alene
authors.initials: A
authors.lastname: Toulany
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ont.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wong
authors.affiliation: Division of Adolescent Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ont. ; University of Toronto, Toronto, Ont. ; Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ont.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Katzman
authors.affiliation: Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ont. ; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
authors.forename: Nadia
authors.initials: N
authors.lastname: Akseer
authors.affiliation: Division of Adolescent Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ont. ; University of Toronto, Toronto, Ont.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Steinegger
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Hancock-Howard
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Coyte