文章基本信息

标题：The Cost-Effectiveness of School-Based Eating Disorder Screening
本地全文：下载
作者：Davene R. Wright ; S. Bryn Austin ; H. LeAnn Noh 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：9
页码：1774-1782
DOI：10.2105/AJPH.2014.302018
语种：English
出版社：American Public Health Association
摘要：Objectives. We aimed to assess the value of school-based eating disorder (ED) screening for a hypothetical cohort of US public school students. Methods. We used a decision-analytic microsimulation model to model the effectiveness (life-years with ED and quality-adjusted life-years [QALYs]), total direct costs, and cost-effectiveness (cost per QALY gained) of screening relative to current practice. Results. The screening strategy cost $2260 (95% confidence interval [CI] = $1892, $2668) per student and resulted in a per capita gain of 0.25 fewer life-years with ED (95% CI = 0.21, 0.30) and 0.04 QALYs (95% CI = 0.03, 0.05) relative to current practice. The base case cost-effectiveness of the intervention was $9041 per life-year with ED avoided (95% CI = $6617, $12 344) and $56 500 per QALY gained (95% CI = $38 805, $71 250). Conclusions. At willingness-to-pay thresholds of $50 000 and $100 000 per QALY gained, school-based ED screening is 41% and 100% likely to be cost-effective, respectively. The cost-effectiveness of ED screening is comparable to many other accepted pediatric health interventions, including hypertension screening. Eating disorders (EDs), including anorexia nervosa, bulimia nervosa, and binge-eating disorder, are prevalent among adolescents. 1 Approximately 3.8% of females and 1.5% of males aged 13 to 18 years have an ED, 2 and 16.3% of US 9th to 12th graders report engaging in disordered eating behaviors such as fasting or vomiting to lose weight. 3 Although efficacious treatments for EDs exist, 4 services for these conditions are underused. 5 Seventy-eight percent to 88% of adolescents with EDs have contact with a health provider; of these youths, however, only 3% to 28% received treatment specifically for eating problems. 1 Left untreated, EDs can significantly affect the length and quality of adolescent lives. 6,7 ED medical complication, hospitalization, and mortality rates are the highest of any psychiatric disorder. 8–11 Like many other chronic mental heath disorders, EDs can be costly to treat and place a considerable burden on patients and their caregivers. Estimates of the annual impact of EDs on health care costs and economic productivity in Australia and England range from US $1.8 billion to $19.2 billion. 12–14 With early diagnosis and timely treatment, we may be able to decrease the economic and health burden of EDs. The American Academy of Pediatrics suggests that schools are a viable setting for health screening. 15 Scoliosis, hearing, body mass index, and other health screenings are currently conducted in US public schools or required for enrollment. 16 Policies designed to identify secondary school students with ED have been introduced in several states (Figure A, available as a supplement to the online version of this article at http://www.ajph.org ). As of September 2013, only 1 state passed legislation aimed at improving detection of EDs, requiring schools to educate parents on how to recognize symptoms of an ED. Three states are currently considering ED-related legislation and ED screening legislation has failed in 2 states (Taryn O’Brien, written communication, September 2013). The impact of school-based screening on ED diagnosis and treatment duration is unknown. No studies have evaluated the health or economic impact of screening for EDs in school-based settings. Given the high proportion of EDs that remain undetected and the fact that no states currently mandate ED screening, experimentally evaluating the benefits of such screening programs in the real world would be resource intensive and may underestimate the potential benefits of screening. However, simulation models can be used to estimate the cost-effectiveness of screening with few constraints. 17 We used a decision-analytic simulation model to evaluate the cost-effectiveness of a theoretical school-based ED screening program.