About three quarters of total obesity co
Obesity is known to approximately double health care costs in the United States compared to people at a healthy weight. A series of five studies presented this year at the European Congress on Obesity (ECO2022), in Maastricht, the Netherlands and online May 4-7, now shows that around three-quarters of the total costs of obesity for the health system among people with obesity in the United States are represented by the 20% of the most costly cases.
The studies were led by Dr Marc Evans, University Hospital, Llandough, Penarth, Cardiff, UK, and Dr Jonathan Pearson-Stuttard, Head of Health Analytics at data and analytics firm Lane Clark & Peacock LLP, London, UK, and colleagues.
The five studies covered an 8-year period and included 28,583 obese people in the United States. The authors conclude that: “Health care costs and hospitalization rates are higher for people in higher obesity classes than for lower classes. Our results highlight the relationship between body mass index (BMI) and increasing use of healthcare resources and suggest that the progression of obesity may contribute significantly to the economic burden of disease.
Adults (18 years and older) were identified in the IQVIA Ambulatory Electronic Medical Records Database and linked to the IQVIA PharMetrics Plus Claims Administrative Database, two databases commonly used for large-scale research purposes . Individuals with a BMI of 30 to 70 kg/m² during a reference period (January 1, 2007 to March 31, 2012) and continuously registered in the database for at least one year before their reference year and 8 years of follow-up ( up to 2020) were included in the analysis; those who were pregnant or had cancer at the start of the study were excluded. The index date was the date the person had their BMI measured.
Three cohorts were formed according to obesity class: (class I: BMI 30–health care costs per person (hospitalization, outpatient, and pharmacy costs; measured in 2019 US dollars) were assessed over the course of the baseline year and year 8. High-cost cases were defined as the 20% of cases with the highest total costs in year eight; the remaining cases were designated in the low-cost category.
For the class I obesity group, the 20% of individuals who had the highest healthcare costs accounted for 79% of all healthcare costs for this group; for those with class II obesity, this figure was 77% and for the class III obesity group, 74%. The authors state, “We found that at least three-quarters of the total direct health care costs for people with obesity in US clinical practice came from 20% of individuals. People in the high-cost obesity category had significantly more obesity-related complications than people in the low-cost category, suggesting a clear association between obesity-related complications and economic burden.
A second analysis from the same study population estimated how many CROs (obstructive sleep apnea, heart failure, urinary incontinence, knee osteoarthritis, type 2 diabetes, prediabetes, asthma, psoriasis, gastroesophageal reflux disease, hypertension, dyslipidemia, musculoskeletal -skeletal, atherosclerotic cardiovascular disease and chronic kidney disease/kidney failure) were present in obese people at the start of the study.
The authors found that among 28,583 obese people, 12,686 (44%) had no CRO, 7,242 (25%) had one CRO, 4,180 (15%) had two CROs, and 4,475 (16%) had three or more CROs. The more ORC an individual had, the higher their health care costs at the start of the study; and mean costs increased for all groups over the 8 years of the study, indicating worsening of ORCs or development of others in all categories.
Each year, the costs increased with the number of ORCs; average annual costs per person were highest for individuals with 3 or more ORCs (year 0, $14,290; year 8, $20,078) and lowest for those without index ORCs (year 0, 1 $626; year 8, $7,015). For patients with 1 ORC or 2 ORCs, the costs were $4,649 and $7,089 at year 0, and $9,296 and $11,738 at year 8, respectively.
A third analysis showed a general trend of increasing cumulative costs per patient with increasing obesity class for most ORCs, including established cardiovascular diseases (CVD; 126,834 USD; 142,817; and 150,579 for classes I, II and III, respectively), heart failure (USD180, 140; 188,507; and 243,539) and chronic kidney disease (USD227,702; 284,414; and 298,194).
Costs also increased with levels of obesity severity for subgroups of individuals with at least two CROs ($101,708; 110,709; and 111,633) or three or more CROs ($127,646; 133 $378 and $135,521); and also for people without ORC (39,951 USD; 44,156 and 47,623). For some ORCs (osteoarthritis, atherosclerotic CVD, and type 2 diabetes), there were no consistent differences between obesity classes.
A fourth analysis examined the prevalence of selected ORCs across obesity classes and found that in all three obesity classes, type 2 diabetes was approximately twice as common at the end of the 8-year study period as he wasn’t at first. In the class I obesity group, the proportion of people with type 2 diabetes increased from 7% to 13%; in the class II obesity group, the prevalence of type 2 diabetes increased from 11% to 23%; and in the class III group, the prevalence of type 2 diabetes increased from 16% to 31%.
From grades one to eight, the prevalence of chronic kidney disease increased 3.3 times (class I obesity), 6.7 times (class II obesity), and 5.5 times (class III obesity), while obstructive sleep apnea increased by 2.6 times (class I obesity), 80% (class II obesity) and 60% (class III obesity).
The fifth and final analysis studied the differences in hospitalizations and hospital costs between classes of obesity and the evolution of these costs. Average health care costs increased over the 8-year study period for all three obesity classes, but more so for class III (36%) and class II (41%) obese people compared to class I (24%). Eighth grade costs were 27% higher for obesity class II ($11,809) compared to class I ($9,291) and were 34% higher for class III ($12,472) compared to compared to class I (9,291 USD).
The proportion of people hospitalized each year was slightly higher as obesity severity increased, however, the number of hospitalizations among those hospitalized was the same across all three obesity categories: 1.3 hospitalizations per year , and unadjusted annual hospitalization costs per person were generally similar. for the three classes of obesity (see figure in the poster).
“These results provide clear evidence that people with obesity face a wide range of comorbidities that tend to increase over time and with obesity severity, with substantial impact on the use of health resources. health care and financial implications for health systems,” says Dr Pearson-Stuttard.
Dr Evans adds: “The implications are that effective weight management to prevent obesity or its progression is therefore likely to both reduce morbidity and reduce cost pressures on healthcare systems.”
Dr Marc Evans, University Hospital, Llandough, Penarth, Cardiff, UK. Contact by email. E) [email protected]
Dr Jonathan Pearson-Stuttard, Head of Health Analytics at data and analytics firm Lane Clark & Peacock LLP, London, UK. Contact by email. E) [email protected]
Alternate contact at ECO Press Center Tony Kirby T) +44 7834 385827 E) [email protected]
This press release is based on five studies from the European Obesity Congress (ECO 2022). The material was reviewed by the congress selection committee. There is no complete document at this stage.
Conflict of Interest Statement
The studies were sponsored by Novo Nordisk A/S, a leading global healthcare company and a leading researcher and manufacturer of diabetes and obesity drugs, and the employer of several of the co-authors .