A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder

Eat Weight Disord. 2016 Sep;21(3):353-364. doi: 10.1007/s40519-016-0264-x. Epub 2016 Mar 4.


Purpose: To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

Methods: A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro.

Results: Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively.

Conclusions: AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.

Keywords: Anorexia nervosa; Binge eating disorder; Bulimia nervosa; Cost of illness; Eating disorders; Quality of life.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anorexia Nervosa / diagnosis*
  • Anorexia Nervosa / economics
  • Anorexia Nervosa / psychology
  • Binge-Eating Disorder / diagnosis*
  • Binge-Eating Disorder / economics
  • Binge-Eating Disorder / psychology
  • Bulimia Nervosa / diagnosis*
  • Bulimia Nervosa / economics
  • Bulimia Nervosa / psychology
  • Cost of Illness*
  • Health Status
  • Humans
  • Quality of Life / psychology*