Economic Implications of Obesity Management

1
Economic Implications of Obesity Management
2
Economic Consequences of ObesityWhy Should You
Care?

• Span the ages from childhood through old age
• The costs are borne
• Personally
• By employers
• By the government
• By taxpayers
• Not stratified to Obese and Overweight by cost

3
Economic Burden of Obesity - Similar to Other
Chronic Diseases
Direct cost of chronic diseases in the U.S.
(2003)

• 
  Billions,
• Obesity 1 75.0
• Type 2 Diabetes 2 73.7
• Coronary heart disease 3 52.4
• Hypertension 4 28.2
• Arthritis 5 23.9
• Breast Cancer 6 7.1

1 Finkelstein EA, Obes Res 200412, 4. Hodgson TA
et al. Med Care 200139599, 2 ADA Diabetes
Care, 200326917, 5 Yelin Callahan. Arthritis
Rheum 1995381351, 3 Hodgeson TA et al. Medical
Care 199937994. 5 Brown ML, et al. Medical
Care 200240(suppl) IV-104, Courtesy of Anne
Wolf, MS, RD.
4
Obesity Contribution to Health Care Costs
Wolf AM, Colditz GA. Obes Res. 1998697.
5
Estimated Obesity-Attributable U.S. Business
Health Care Spending on Selected Diseases
85.5
27.0
46.8
46.0
36.2
18.7
19.0
15.9
Thompson D, Edelsberg J, Kinsey K, Oster G, et
al. Estimated Economic Costs of Obesity to U.S.
Business. Am J Health Promot 1998 13(2) 120-127.
6
Health Care costs of Obesity
Costs Stratified by BMI

BMI body mass index. Rate ratio reference group
is BMI 20-25 kg/m2. P value represents
association between BMI and cost or utilization
specified.
Am J of Manage Care, March 1998.
7
Obesity Effect on Expected Lifetime Medical Care
Costs in Men
Costs ()
55-64
45-54
Age (y)
35-44
32.5
27.5
37.5
22.5
Body Mass Index (kg/m2)
Total cost of CHD, type 2 DM, hypertension,
hypercholesterolemia, stroke
Thompson et al. Arch Intern Med 19991592177.
8
Obesity Effect on Expected Lifetime Medical Care
Costs in Women
40,000
30,000
Costs ()
20,000
55 - 64
10,000
45 - 54
Age
35 - 44
0
37.5
32.5
27.5
22.5
BMI (kg/m2)
Total cost of 8 diseases CHD, type 2 DM,
hypertension, hypercholesterolemia, stroke,
gallbladder disease, osteoarthritis of knee,
endometrial cancer.
Adapted from Thompson D et al. Arch Intern Med
19992177-2183.
9
Expected Lifetime Medical Care Savings of
Sustained 10 Weight Loss by Age and Initial BMI
(Women)
6000
5000
4000
Costs ()
3000
55 - 64
2000
45 - 54
1000
Age
35 - 44
0
37.5
32.5
27.5
BMI (kg/m2)
Total cost of 5 diseases CHD, type 2 DM,
hypertension, hypercholesterolemia, and stroke.
Adapted from Oster G, et al. Am J Public Health
1999891536-1542.
10
Medical Resource Use for Obese, Nonobese
Patients - 1Year Data
Two-part regression model (Berk and Lachenbruch
2002)
Raebel, M. et al. Arch Intern Med
200419(164)2135-2140.
11
Cost Difference

• 2.3 - Cost increase for each higher BMI unit
• 52.9 - Cost increase for each major associated
  co-morbidity

Raebel, M. et al. Arch Intern Med
200419(164)2135-2140.
12
Increase Healthcare Costs - Obese Compared with
Lean 17,188 Patients-1 Year Data
Increase in Cost Compared with Lean Subjects ()
BMI 30 - 34 kg/m2
BMI 35 kg/m2
HMO Setting Northern California Kaiser
Permanente
Quesenberry CP Jr et al. Arch Intern Med.
1998158466-472.
13
Economic Impact on Employers

• Bear a major part of the insurance burden for
  their employees
• BMI 30 mg/dl impacts productivity and all
  indirect morbidity outcomes
• Rise in one BMI unit a 1.9 rise in median
  health costs among 5689 managed care members

Pronk NP, et al. JAMA. 1999282235-2239.
14
Economic Effect of Obesity in Workplace
3-Year Costs to First Chicago NBD
1,546
6,822
4,496
683
Absenteeism
Healthcare
BMI 27.8 kg/m2 in men 27.3 kg/m2 in women.
Burton et al. J Occup Environ Med 199840786.
15
Employer Cost of Obesity

• Obesity is associated with
• 39 million LOST work days
• 239 million RESTRICTED activity days
• 90 million BED days
• 63 million PHYSCIAN visits

The National Business Group on Health, Institute
on the Costs and Health Effects of Obesity,
August 2004.
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Employer Costs of Obesity

• Total cost to US companies- 13 billion/year
• Health Insurance Costs- 8 billion
• Paid sick leave costs - 2.4 billion
• Disability insurance - 1 billion

The National Business Group on Health, Institute
on the Costs and Health Effects of Obesity,
August 2004.
17
Employer Cost of Obesity

• 8 of private employer medical claims are due to
  overweight and obesity
• 36 higher in/out patient spending
• 77 higher medication spending
• 45 more inpatient days
• 48 more payments over 5000
• 11 higher annual healthcare costs

The National Business Group on Health, Institute
on the Costs and Health Effects of Obesity,
August 2004.
18
Contribution to Total Cost of Primary Medical
Care California, Year 2000- 2,579,444 Adults
Chenoweth, D. (2005). The Economic Costs of
Physical Inactivity, Obesity, and Overweight
in California Adults During 2000 A Technical
Analysis. Cancer Prevention and Nutrition
Section, California Department of Health
Services, Sacramento, California.
19
Obesity in the Short termIncreases Health Care
Costs
20
Obesity Wage Differentials
Baum C, Ford W. Health Economics. 200413885-899.
21
Obesity Wage Differential by Gender
Baum C, Ford W. Health Economics. 2004.
13885-899.
22
US Navy - Active Duty Personnel

• Obesity-related costs and career outcomes
• 25 of separations and retirements in obesity
  group were attributed to obesity co-morbidity
  (DM, CHD, HBP)

Hoilberg, A. McNally, MS. 1991156276-82.
23
US Air Force - Cost of Overweight

• 20.4 Air Force men - overweight 1997
• 20.5 Air Force women - overweight 1997
• 22.8 million/year - total medical costs of
  excess body weight in Air Force personnel
• 28,351 days/year - as medical overweight lost
  duty days

Robbins. Military Medicine 2002167(5)393-397.
24
9 Year Total Healthcare Costs
Thompson, D. et al. Obes Res. 20019(3)210-218.
25
9 Year Costs of Prescription Drugs
Thompson, D. et al. Obes Res. 20019(3)210-218.
26
9 Year Costs of Outpatient Services
Thompson, D. et al. Obes Res. 20019(3)210-218.
27
Cost Increases Associated with Obesity and 20
Years Aging 1998
Sources Authors calculation based on data from
the Healthcare for Communities (HCC) survey, wave
1. Twenty years aging is from age thirty to
age fifty.
Sturm. R. Health Affairs. March/April 2002.
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Aging Population

• Aging population has important implications for
  expenditures by Medicare
• Medicare is the largest single source of health
  care spending

Daviglus. M. et al. JAMA. 292(22) 2743-2749.
29
Medicare Charges Age 65 Years to Death or Age
83 Years (1984 2002), by Baseline BMI (1967
1973)
Adjusted for baseline age, race (indicator for
black), education (years), and smoking
(cigarettes/d). Additionally, to component of the
consumer price index. For all rows, p for trend across 4 BMI Groups based on BMI as a
continuous variable entered in a modified Cox
regression model. tp the non overweight group (BMI 18.5 24.9) p 0.001 for comparisons with the nonoverweight
group (BMI 18.5 24.9)
Daviglus. M. etal. JAMA. 2004292(22)2743-2749.
30
Medicare Charges

• Baseline BMI related to Medicare costs for
• CVD
• Diabetes
• 7 of Medicare charges are for obesity

Daviglus. M. et al. JAMA. 2004,Vol.292,
No.222743-2749.
31
Difference in Cost in Severely Obese

• 84 higher total difference in charges
  severely obese vs non-overweight men
• 88 higher total difference in charges-
  severely obese vs non-overweight women

Daviglus. M. et al. JAMA. 2004Vol.292,
No.222743-2749.
32

• 9.1 of the total annual US medical expenditures
  in 1998 - attributable medical spending for
  overweight and obesity 78.5 billion
• Medicare and Medicaid finances 50 of the cost

Finkelstein EA. et al. Health Affairs Policy J.
of Health Sphere May 2003.
33
Childhood/Adolescent Health Costs

• 9 20 Cost of a single day of absenteeism
  for a student
• 9 days Median sick days away from school for
  the most overweight students
• Obesity associated annual hospital costs for
  children and youth more than tripled over the
  last two decades
• 35 million in1979 1981
• 127 million in 1997 1999

Action for Healthy Kids- The Learning Connection-
Value of Improving Nutrition and Physical
Activity in Our Schools. Preventing Childhood
Obesity Health in the Balance. 2005. Institute
of Medicine. Childhood Obesity Prevention Study.
34
Obesity Medications

• Obesity medications produced substantial weight
  loss
• Drug cost savings for obesity co-morbid
  conditions
• Subjects were taking medications for
• Diabetes
• Hyperlipidemia
• Hypertension
• Pharmaceutical cost computed for
• Weight loss
• Cardiac risk reduction
• Lipid reduction
• Glucose reduction

Greenway FL, Ryan DH, Bray GA. Obesity Research.
19997523-531.
35
Weight Management for Diabetes, Hypertension,
and Dyslipidemia - Saves Money
Loss From Initial Weight
Obesity Comorbidity Diabetes (insulin RX)
104 7 Diabetes (sulfonylurea Rx) 55
7 Hypertension 20 10 Dyslipidemia 61
5
Savings/ Month
Greenway FL, Ryan DH, Bray GA. Obesity Research.
19997523-531.
36
Quality of Life and Obesity

• Quality of life - altered by obesity
• Quality of life - decreases with increasing
  obesity
• Quality of life - slightly worse for women
  compared to men

Livingston EH, Ko CY. Obesity Research. 2002
824-832.
37
Quality of Life for the Obese Patient

• Most obese have the poorest quality of life
• Quality of Life improves with weight loss

Kolokin, R. et al. Obesity Research. 2001.
38
Five Keys

• Obesity is a serious problem.
• Risk assessment drives treatment options.
• Modest weight loss Major health benefits.
• Lifestyle is the foundation of treatment.
• PCPs have special role
• Promote lifestyle for all patients.
• Help patients with weight loss, including
  prescribing and referral for surgery.

39
Weight Loss and IWQOL-Lite Scores
Kolokin, R. et al. Obesity Research. 2001.
40
Effect of Obesity and 20 Years Aging on Chronic
Medical Conditions and Health-Related Quality of
Life, 1998
Obese 20 years aging Smoking (current) Overweigh
t Problem drinking Smoking (past)
2.0 1.5 1.0 0.5 0.0
Decline in health-related quality of life (0 -
100 scale)
Increase in number of chronic conditions
Sources Authors calculation based on data from
the Healthcare for Communities (HCC) survey, wave
1. Twenty years aging is from age thirty to
age fifty.
Effects of Obesity, Smoking and Drinking on
Medical Problems and Costs. Sturm. R. Health
Affairs. March/April 2002.