Psychological Medicine

Review Article

The health service use and cost of eating disorders

JUDIT SIMON a1a2c1, ULRIKE SCHMIDT a3, STEPHEN PILLING a2 and   on behalf of the Eating Disorders Guideline Development Group 1
a1 Health Economics Research Centre, Department of Public Health, University of Oxford, UK
a2 National Collaborating Centre for Mental Health, Centre for Outcomes Research and Effectiveness, Sub-Department of Clinical Health Psychology, University College of London, UK
a3 Section of Eating Disorders, Institute of Psychiatry, London, UK

Article author query
simon j   [PubMed][Google Scholar] 
schmidt u   [PubMed][Google Scholar] 
pilling s   [PubMed][Google Scholar] 


Background. The economic burden and health service use of eating disorders have received little attention, although such data are necessary to estimate the implications of any changes in clinical practice for patient care and health care resource requirements. This systematic review reports the current international evidence on the resource use and cost of eating disorders.

Method. Relevant literature (1980–2002) was identified from searches of electronic databases and expert contacts.

Results. Two cost-of-illness studies from the UK and Germany, one burden-of-disease study from Australia and 14 other publications with relevant data from the UK, USA, Austria, Denmark and The Netherlands could be identified. In the UK, the health care cost of anorexia nervosa was estimated to be £4·2 million in 1990. In Germany, the health care cost was €65 million for anorexia nervosa and €10 million for bulimia nervosa during 1998. The Australian study reported the health care costs of eating disorders to be Aus$22 million for year 1993/1994. Other costing studies focused mostly on in-patient care reporting highly variable estimates. There is a dearth of research on non-health care costs.

Conclusions. The limited available evidence reflects a general under-detection and under-treatment of eating disorders. Although both cost-of-illness studies may significantly underestimate the costs of eating disorders because of important omitted cost items, other evidence suggests that the economic burden is likely to be substantial. Comprehensive data on the resource use of patients with eating disorders are urgently needed for better estimations, and to be able to determine cost-effective treatment options.

(Published Online April 1 2005)

c1 Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. (Email:


1 Members of the group are listed in the Appendix.