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Uppsala Health Economics (UHE), in collaboration with the Child Health and Parenting Research Group (CHAP) at the Department of Public Health and Caring Sciences at Uppsala University invites researchers, doctoral and master students in health economics, health services research, or related areas to the 2nd Workshop series on Health Economics Methods with Associate Professor Claire de Oliveira.

Dr. Claire de Oliveira is an associate professor in the Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto. She is also a senior scientist and senior health economist with the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health, a senior adjunct scientist in the Mental Health and Addictions Program at ICES, and an honorary senior lecturer at the Hull York Medical School, University of York, United Kingdom. In addition to her academic appointments, Dr. de Oliveira currently serves as a board member of the International Health Economics Association and as a member of the international editorial board of the British Journal of Psychiatry. Dr. de Oliveira has published extensively in the mental health economics and mental health services research fields, with several notable publications in high-impact journals, such as Health Affairs, the Lancet Psychiatry, and the Canadian Medical Association Journal. She has extensive experience working with administrative health care and survey data and has expertise in data and regression analysis and economic analyses.

📅 Date: Friday, May 9^th
🕥 Time: 10.00 AM – 12.00 PM (GMT+2)
📍 Location: IFV (A11:220), BMC (or via Zoom)
🔹 Topic: Models for Skewed Outcomes

This workshop will cover several different estimators: count models, generalized linear models, quantile regression models, and finite mixture models that are to be used when dealing with skewed outcomes.

Recommended reading: Deb P, Norton EC. Modeling Health Care Expenditures and Use. Annu Rev Public Health. 2018. Deb P, Trivedi P. Empirical models of healthcare use. In Andrew Jones, ed., Elgar companion to health economics. Second edition. Edward Elgar, 2012.

📅 Date: Thursday, May 15^th
🕥 Time: 10.30 AM – 12.00 PM (GMT+2)
📍 Location: IFV Boströmsrummet (A11:219), BMC (or via Zoom)
🔹 Topic: Estimating Treatment Effects Using Observational Data: Instrumental Variables and Regression Discontinuity

This workshop will review different methodologies typically used in health economics to estimate treatment effects when using observational data.

Recommended reading: Murray, M. P., The Bad, the Weak, and the Ugly: Avoiding the Pitfalls of Instrumental Variables Estimation (2006) Imbens G, Lemieux T. Regression Discontinuity Designs: A Guide to Practice. 2007.

📅 Date: Monday, May 26^th
🕥 Time: 13.00 PM – 15.00 PM (GMT+2)
📍 Location: IFV Boströmsrummet (A11:219), BMC (or via Zoom)
🔹 Topic: Introduction to Microsimulation

This workshop will introduce the microsimulation techniques and their applications in health economics research.

Don’t miss the opportunity. Register now here!

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Previous studies have shown that the economic burden of eating disorders is substantial [8–10]. Due to the high costs of care in this population, well-organised efforts directed toward early intervention and active management of these individuals’ physical and mental health are warranted. Furthermore, given the surge in eating disorders-related emergency department visits and medical hospitalizations (i.e., acute care) among young women in Canada throughout the pandemic [11], it is important to understand whether there are ways to improve care among this particular population. Many jurisdictions have implemented strategies, such as high-risk care management, to reduce costs and improve the quality of care among patients with high health care needs. High-risk care management involves the provision of intensive, one-on-one services by a health worker, such as a nurse, to patients with complex needs, such as those with an eating disorder. The idea behind these types of strategies/interventions is that the implementation of high-quality outpatient care may help reduce unnecessary acute care for these patients. For example, research suggests that stepped care models, where primary care clinicians play a greater role in service delivery, may be an option to improve patient outcomes in a cost-effective manner [12]. However, it is unclear whether any costs can be reduced, and if so which, especially among patients who require costly care.

How to reduce unnecessary health care spending?

One potential way to decrease health care spending, without sacrificing high-quality care, may be to target preventable (i.e., potentially unnecessary) acute care among patients with high health care utilisation. Previous work has estimated preventable care among the general population, disease-specific sub-populations, and patients with high health utilisation and costs, but work of this nature has not been carried out for individuals with eating disorders.

Although the economic burden of eating disorders to health care systems is substantial, there is some scope to decrease acute care spending among this patient population. Among a population-based sample of individuals ever hospitalized for an eating disorder, 15% of all acute care spending (i.e., $1,330,839.94 CAD) was for treatable conditions. Among hospitalisations, the highest proportions of preventable care spending were for inpatient episodes related to short-term diabetes complications and urinary tract infections. Among emergency department visits, the highest proportions of preventable care spending were for ambulatory episodes that involved non-emergent conditions (i.e., conditions that do not require immediate medical care within a 12-hour window), such as hip pain, and emergent but primary care treatable conditions (i.e., conditions that require care within a 12-hour window but could have been treated effectively with appropriate primary care management), such as an adverse effect to a drug. By sub-group, preventable acute care spending was higher for females (14%) and those with a diagnosis of bulimia nervosa (21%) [13].

Overall, these findings suggest that providing better diabetes care, which could support individuals in normalizing eating patterns and improving diabetes control [14], could potentially help reduce diabetes-related hospitalisations. Moreover, it is likely that care coordination between health care providers and improved access to primary care and disease prevention, particularly related to diabetes, may help prevent the occurrence of some emergency department visits. Primary care clinicians could play a greater role in delivering care as part of a stepped care model, where patients first receive self-help, and then be “stepped” to outpatient and subsequently further to inpatient care, if they do not respond to the preceding step [12]. These models have been shown to not only improve patient outcomes but also be cost-effective [12]. Cost-savings resulting from the reduction of unnecessary acute care could provide further economic justification for increased investment in outpatient care for individuals with eating disorders.

Citation: de Oliveira C (2024) Caring for individuals with eating disorders–how to improve care while reducing unnecessary spending? PLOS Ment Health 1(5): e0000160. https://doi.org/10.1371/journal.pmen.0000160

Published: October 28, 2024

References

1. Hudson JI, Hiripi E, Pope HGJ, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61: 348–358. pmid:16815322

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2. Agras WS. The consequences and costs of the eating disorders. Psychiatr Clin North Am. 2001;24: 371–379. pmid:11416936

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3. Samnaliev M, Noh HL, Sonneville KR, Austin SB. The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the U.S. Medical Expenditures Panel Survey. Prev Med reports. 2015;2: 32–34. pmid:26844048

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4. Pritts SD, Susman J. Diagnosis of eating disorders in primary care. Am Fam Physician. 2003;67: 297–304. pmid:12562151

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5. Mitchell JE, Crow S. Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry. 2006;19: 438–443. pmid:16721178

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6. Robinson L, Aldridge V, Clark EM, Misra M, Micali N. A systematic review and meta-analysis of the association between eating disorders and bone density. Osteoporos Int a J Establ as result Coop between Eur Found Osteoporos Natl Osteoporos Found USA. 2016;27: 1953–1966. pmid:26782684

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7. Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68: 724–731. pmid:21727255

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8. de Oliveira C, Macdonald EM, Green D, Colton P, Olmsted M, Bondy S, et al. Cost evaluation of out-of-country care for patients with eating disorders in Ontario: a population-based study. C open. 2016;4: E661–E667. pmid:28018879

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9. de Oliveira C, Colton P, Cheng J, Olmsted M, Kurdyak P. The direct health care costs of eating disorders among hospitalized patients: A population-based study. Int J Eat Disord. 2017;50: 1385–1393. pmid:29105807

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10. Streatfeild J, Hickson J, Austin SB, Hutcheson R, Kandel JS, Lampert JG, et al. Social and economic cost of eating disorders in the United States: Evidence to inform policy action. Int J Eat Disord. 2021;54: 851–868. pmid:33655603

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11. Toulany A, Kurdyak P, Guttmann A, Stukel TA, Fu L, Strauss R, et al. Acute Care Visits for Eating Disorders Among Children and Adolescents After the Onset of the COVID-19 Pandemic. J Adolesc Heal Off Publ Soc Adolesc Med. 2022;70: 42–47. pmid:34690054

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12. Pehlivan MJ, Miskovic-Wheatley J, Le A, Maloney D, Research Consortium NED, Touyz S, et al. Models of care for eating disorders: findings from a rapid review. J Eat Disord. 2022;10: 166. pmid:36380363

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13. de Oliveira C, Tanner B, Colton P, Kurdyak P. Understanding the scope of preventable acute care spending among patients with eating disorders. Int J Eat Disord. 2023;56: 1156–1187. pmid:36757092

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14. Winston AP. Eating Disorders and Diabetes. Curr Diab Rep. 2020;20: 32. pmid:32537669

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International Day of Happiness is part of Sustainable Development Goal 3 -Good Health and Wellbeing- and emphasizes mental health and well-being and the role of sustainability in happiness.

Mental health prevention programs are essential to improving children’s lives and ultimately societies

There are approximately 2.5 billion children and adolescents in the world, and most of them live in low-income and middle-income countries. For these children and adolescents, mental illness remains one of the leading causes of the global burden of disease and years lived with disability. Although the importance of child and adolescent mental health has been acknowledged by organizations such as the United Nations, the absence of inclusive mental health systems for children and adolescents shows global inaction.

Recent evidence-based studies suggest that interventions in early life to protect the well-being and mental health of young children and their families can generate positive outcomes, not only for health, but for other sectors of society, such as education, employability, and justice.

Our commitment at UHE

Children’s mental health is a growing area of concern, with long-term implications for well-being, education, and societal development. We are dedicated to improving the lives of children and their families. Our research in this field focuses on evaluating interventions that promote early detection, prevention, and treatment of mental health issues among children and adolescents.

Our research in Mental Health

🌍 Cost and effects of a universal parenting programme delivered to parents of preschoolers - Assessing the costs and effects of a universal program delivered to parents and preschool children.

🏫 Health, public sector service use and related costs of Swedish preschool children: results from the Children and Parents in Focus trial - Identifying the proportion of preschool children with mental health and somatic problems, investigating whether other factors affect service use, and estimating the costs associated with these services.

👪 Quality of life and service use amongst parents of young children: Results from the Children and Parents in Focus trial - Assessing the quality of life (QoL) and service use of parents who have preschool-aged children.

🧠 Evidence for investing in parenting interventions aiming to improve child health: a systematic review of economic evaluations - Provide an up-to-date synthesis of the available health economic evidence for parenting interventions aiming to improve child health.

Join the movement!

“We don’t have to engage in grand, heroic actions to participate in the process of change. Small acts, when multiplied by millions of people, can transform the world” - Howard Zinn (Day of Happiness).

Want to learn more about the work we do in this space? Reach out if you are interested in collaborating or learning more 👉 Get in touch!

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The Global Impact of Self-harm and Self-injury

Recent studies estimate that around 14.6 million people globally engage in self-harm each year. This behavior is particularly prevalent among young people, affecting 1 in 12 adolescents, with approximately 10% of those aged 15–16 years old impacted.

Self-harm or -injury is often a result of external factors, such as past experiences of being bullied or bullying, neglected, sexually, or physically abused, or other traumatic events. Emotional trauma and negative feelings -depression, anxiety, and stress, can also lead to self-harm and -injury.

In some cases, self-harm and -injury can result in an unintentional suicide. Globally, it is estimated that more than 120,000 young people aged under 25 years die from self-inflicted causes each year (Undercounting of suicides: Where suicide data lie hidden).

The Role of Research in Fighting Self-injury and Suicide

At Uppsala Health Economics, we acknowledge the urgent need for robust research to guide decision-making and shape sustainable healthcare solutions. Our work contributes to global efforts to address self-harm and suicide prevention through evidence-based interventions, ensuring that policies are both effective and economically viable.

Our Research in Mental Health and Suicide

📢 Here are some of our team’s work related to mental health and suicide prevention:

🤕 The societal cost of suicide in Sweden 2022 - Estimating both direct and indirect costs associated with suicide and highlighting areas for targeted intervention and prevention strategies. (Report only available in Swedish)

🧑‍⚕️Economic Evaluations of Public Health Interventions to Improve Mental Health and Prevent Suicidal Thoughts and Behaviours: A Systematic Literature Review - Reviewing the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide.

🧑‍🧑‍🧒 A pilot study of the impact of an integrated individual- and family therapy model for self-harming adolescents on overall healthcare consumption - Investigating the cost of an integrated individual and family therapy and comparing the adolescent's healthcare consumption 1 year before and 1 year after treatment.

Join in recognizing this day!

On Self-Injury Awareness Day, we stand with individuals, healthcare professionals, and advocates working to address the global challenge of self-harm and self-injury and its impact on health and well-being.

📢 Self-harm and -injury are more than a lifestyle issue—there are complex health conditions with significant societal and economic costs. Research plays a crucial role in finding effective prevention and treatment strategies.

💡 Want to learn more about mental health and suicide prevention? Get in touch!

Let’s work together to raise awareness, improve access to care, and create a healthier future for all. 💙🌍 #SIAD2025 #SelfHarmAwareness #OrangeRibbon #MentalHealth #HealthEconomics #SuicidePrevention #EvidenceBasedPolicy

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Children’s Rights Are Human Rights

Every child deserves a safe, healthy, and nurturing environment—one where they can grow, learn, and thrive. Yet, millions of children worldwide still lack access to basic healthcare, education, and protection. Addressing these issues requires action, research, and collaboration at all levels.

Our Contribution to Child Health

At UHE, we are committed to making a difference in children’s lives through health economics research. By evaluating healthcare interventions and policies, we aim to improve child health outcomes and ensure that resources are used effectively to support children’s well-being. We work closely with national and international partners to drive evidence-based change.

Our Research in Child Health

📢 Here are some of our team’s recent publications on child health:

🧒 Evidence for investing in parenting interventions aiming to improve child health - Providing an up-to-date synthesis of the available health economic evidence for parenting interventions aiming to improve child health.

🧒 Evaluation of a Universal Early Intervention for Parents and Children – Analyzing the health and economic outcomes of an early childhood intervention from birth to age five in Northern Sweden.

👶 Long-term Effects of Developmental Coordination Disorder – Investigating the impact of childhood developmental disorders on education and adulthood outcomes using Swedish register data.

🚸 Cost-effectiveness of Cognitive-Behavior Therapy for Pediatric OCD – Assessing the cost-effectiveness of internet-delivered CBT compared to face-to-face therapy for children with OCD in Sweden.

Looking Ahead: A Commitment to Action

This World Children’s Day, we reaffirm our dedication to advancing children’s health through evidence-based research. Our work is driven by the belief that every child deserves equal access to quality healthcare and opportunities for a brighter future.

💡 Interested in learning more about our research? Get in touch!

Let’s work together to create a healthier, more equitable world for all children. 💙✨

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