The cost-effectiveness of school-based eating disorder screening

Abstract

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.

FIGURE 1—

Schematic of Markov microsimulation model used to estimate the potential costs and health benefits of school-based eating disorder screening. Note. ED = specified eating disorder; OSFED = other specified feeding or eating disorders. “Specified” ED represents anorexia nervosa, bulimia nervosa, or binge-eating disorder. Students move between each health state (circle) based on probabilities derived from the literature. Arrows indicate pathways between heath states. Dashed lines indicate pathways modified by screening: (1) stay healthy for another year, (2) develop ED, (3) develop OSFED, (4) remain ill for another year, (5) progress to ED, (6) partially recover from ED, (7) recover, (8) relapse, and (9) remain recovered for another year.

FIGURE 2—

Sensitivity analyses of the potential cost-effectiveness of school-based eating disorder screening. Note. AN = anorexia nervosa; BED = binge-eating disorder; BN = bulimia nervosa; ICER = incremental cost-effectiveness ratio; OSFED = other specified feeding or eating disorders; QALY = quality-adjusted life-year. This figure reports ICERs for a series of 1-way sensitivity analyses on key input parameters. ICERs that are dominated represent scenarios in which screening was more expensive, but slightly less effective, than usual care.