title: Cost evaluation of out-of-country care for patients with eating disorders in Ontario: a population-based study.
abstract: BACKGROUND
  Eating disorders, specifically anorexia nervosa, bulimia nervosa and eating disorder not otherwise specified, represent a substantial burden to the health care system. Our goal was to estimate the economic burden of patients who received specialized inpatient care for an eating disorder out of country.
  
  
  METHODS
  We conducted a cost-of-illness study evaluating health care costs among patients in Ontario who received specialized inpatient care for an eating disorder out of country from 2003 to 2011, from the public third-party payer perspective. Using linked administrative databases, we estimated net costs of eating disorders for 2 patient groups: those who received specialized inpatient care both out of country and in province (n= 160), and those who received specialized inpatient care out of country only (n= 126).
  
  
  RESULTS
  Patients approved for specialized out-of-country inpatient care were mostly girls and young women from high-income, urban neighbourhoods. Total net costs varied annually and were higher for patients treated both out of country and in province (about $11 million before 2007, $6.5 million after) than for those treated out of country alone (about $5 million and $2 million, respectively). The main cost drivers were out-of-country care and physician services.
  
  
  CONCLUSIONS
  Costs associated with eating disorder care represent a substantial economic burden to the Ontario health care system. Given the high costs of out-of-country care, there may be opportunity to redirect these funds to increase capacity and expertise for eating disorder treatment within Ontario.
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Claire
authors.initials: C
authors.lastname: de Oliveira
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Macdonald
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Diane
authors.initials: D
authors.lastname: Green
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Patricia
authors.initials: P
authors.lastname: Colton
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Marion
authors.initials: M
authors.lastname: Olmsted
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Susan
authors.initials: S
authors.lastname: Bondy
authors.affiliation: Centre for Addiction and Mental Health (de Oliveira, Kurdyak); Institute for Health Policy, Management and Evaluation (de Oliveira, Kurdyak), University of Toronto; Institute for Clinical Evaluative Sciences (de Oliveira, Macdonald, Green, Bondy, Kurdyak); Toronto General Hospital (Colton, Olmsted), University Health Network; Department of Psychiatry (Colton, Olmsted, Kurdyak), University of Toronto; Dalla Lana School of Public Health (Bondy), University of Toronto, Toronto, Ont.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak