When hospital is the problem: building the economic case for treating eating disorders at home

When a teenager is admitted to hospital for an eating disorder, the clinical logic is straightforward: stabilise, nourish, monitor. But hospital wards can work against recovery. Admission disrupts education, separates young people from family and friends, and can reinforce the very behaviours treatment is trying to change. And demand is rising – over the past two decades, referrals to adolescent eating disorder services across the UK have climbed steadily, putting pressure on inpatient beds that were already scarce.

The Thames Valley Provider Collaborative recognised this tension and developed Hospital at Home (H@H) – a programme that delivers intensive eating disorder treatment in the young person's own home, reducing reliance on inpatient admission. Oxford Health NHS Foundation Trust has been running and evaluating the programme since 2021. But a critical piece of evidence was missing: does this model represent good value for the NHS? Clinicians and commissioners needed economic evidence before they could confidently invest in scaling it.

Our approach and partners

ARC OxTV funded a health economic evaluation to answer that question. Researchers at the University of Oxford built a decision-tree model comparing the costs and outcomes of H@H against inpatient care alone, drawing directly on three years of clinical data (2021–2024) from Oxford Health NHS Foundation Trust's own evaluation of the programme.

The work was carried out in close partnership with the Thames Valley Specialised Children and Young People's Mental Health Services Provider Collaborative, based within Oxford Health. Trust clinicians provided iterative feedback on model structure and assumptions and supplied cost and outcome data – grounding the economic analysis in the realities of service delivery rather than theoretical projections.

What we found – and why it matters

The economic evaluation is ongoing, with results expected to show:

1. The cost-effectiveness of home-based treatment compared with inpatient care alone, expressed as cost per clinically meaningful improvement in young people's mental health outcomes.
2. Which components of community-based care work – for whom and under what conditions – giving commissioners practical intelligence for service design, not just a headline cost figure.
3. Whether H@H can reduce avoidable readmissions, a key driver of cost in eating disorder services.

Beyond these primary outputs, the project is developing reusable economic modelling approaches and cleaned datasets that can be applied to future evaluations of community-based mental health services.

What this means

If the analysis confirms that H@H delivers comparable or better outcomes at lower cost, it gives Integrated Care Boards a credible evidence base for investing in home-based eating disorder care – potentially making specialist treatment available closer to home for young people who currently face long waits or distant placements. For families, that could mean less disruption, more involvement in their child's care, and a recovery process that fits around the young person's life rather than replacing it.

What needs to happen next

The findings need to reach the people who make commissioning decisions. ICB commissioners across the Thames Valley – and potentially beyond – should be closely involved as the results emerge, so that economic evidence translates directly into service planning rather than sitting in a report. Patients and families also need to know that Hospital at Home exists as a care option.

Longer-term, further analysis should extend the time horizon to capture outcomes beyond initial clinical improvement, using additional years of comparator data. That work will require sustained analytic capacity for health economic modelling and support to address the practical constraints of implementation.