Modelling Excess Public Expenditure on Emergency Department and Inpatient Care Associated with Gambling Disorder in Spain

Background: Evidence on healthcare expenditure associated with gambling disorder (GD) remains limited in Spain. This study modelled annual excess emergency department and inpatient expenditure per adult with GD and nationally. Methods: A prevalence-based cost model applied international adjusted healthcare-use odds ratios to Spanish baseline probabilities, using a one-episode approximation and national DSM-5 GD prevalence. Hospitalisation was valued at the provisional 2024 SNS mean (EUR 6004.93 per discharge); emergency attendance used the EUR 185 Madrid tariff introduced in December 2023. Deterministic and restricted probabilistic analyses examined uncertainty; additional scenarios examined source choice, episode intensity and overlap. Results: The updated base-case estimate was EUR 1354.17 per adult with GD and EUR 346.32 million nationally; hospitalisation contributed 98.1% of this two-service total. Varying its odds ratio across the reported confidence interval gave EUR 109.67–EUR 691.76 million. Using an alternative adjusted inpatient association from the emergency-use source reduced the total to EUR 44.60 million, demonstrating sensitivity to source selection. Conclusions: The model estimates selected excess emergency and inpatient expenditure associated with GD under explicit assumptions. Diagnostic, comparator and outcome differences limit transferability to Spain. These estimates are neither a validated lower bound nor evidence of causally attributable expenditure or intervention savings.