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COST OF ILLNESS STUDIES. PREVALENCE-BASED ANALYSES COSTS INCURRED DURING YEAR BY PERSONS WITH A PARTICULAR ILLNESS ESTIMATES MAGNITUDE OF DISEASE COSTS ON ANNUAL BASIS ASSESSES ECONOMIC BURDEN ATTRIBUTABLE TO ACUTE OR TRANSIENT CONDITIONS

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cost of illness studies
COST OF ILLNESS STUDIES
  • PREVALENCE-BASED ANALYSES
    • COSTS INCURRED DURING YEAR BY PERSONS WITH A PARTICULAR ILLNESS
    • ESTIMATES MAGNITUDE OF DISEASE COSTS ON ANNUAL BASIS
    • ASSESSES ECONOMIC BURDEN ATTRIBUTABLE TO ACUTE OR TRANSIENT CONDITIONS
    • DOES NOT QUANTIFY LONG-TERM CONSEQUENCES OF BEHAVIOR OR ILLNESS

--- Colditz, 1992

slide2
INCIDENCE-BASED ANALYSES
    • REQUIRES RELIABLE ESTIMATES OF THE INCIDENCE OF DISEASE ATTRIBUTABLE TO OBESITY AT EACH AGE AND FOR EACH GENDER
    • CAN PROVIDE ESTIMATES FOR THE LIFETIME COST OF OBESITY
          • - -- Colditz, 1992
economic costs
ECONOMIC COSTS
  • DIRECT COSTS
    • VALUE OF RESOURCES
    • PERSONAL HEALTH CARE, HOSPITAL CARE, PROFESSIONAL SERVICES, MEDICATIONS)
  • INDIRECT COSTS
    • VALUE OF LOST OUTPUT DUE TO MORBIDITY (WAGES LOST)OR MORTALITY (VALUE OF FUTURE EARNINGS LOST)
          • --- Colditz, 1992
economic cost of obesity
ECONOMIC COST OF OBESITY
  • NIDMM -11.5 BILLION
  • GALL BLADDER DISEASE 2.4 BILLION
  • CVD (EXCLUDING HTN) 22.2 BILLION
  • HTN 1.5 BILLION
  • CANCER 1.9 BILLION
      • TOTAL COST = $39.3 BILLION OR 5.5% OF TOTAL COSTS OF ILLNESS IN 1986
          • ----Colditz, 1992
slide5

REVISED ESTIMATE OF COST BY INCLUDING MUSCULOSKELETAL DISEASES (1990)DIRECT COST OF TREATING OBESITY IN THE US IS $45.8 BILLION OR 6% OF THE TOTAL EXPENDITURE OF HEALTH CARE IN US---Wolf and Colditz, 1994

slide6

UK

Cost of treating obesity in UK estimated at 195 million pounds

---West, 1994

uk 2002
UK (2002)
  • Cost of obesity (BMI greater than 30) was around 3340-3724 million pounds
  • If costs of being overweight are included (BMI 25-30) then the total annual cost of obesity and overweight would be around 6.6- 7.4 billion pounds
  • 2.3- 2.6% of total net National Health Service expenditure in 2001-2002
uk 2002 continued
UK 2002 (continued)
  • Lost earnings 2350-2600 million pounds
  • 34,000 deaths annually attributable to obesity
  • Probability of being in employment is significantly lower (up to 25%) for obese compared to those of normal weight
  • Obese may be discriminated in labor market
  • Obese may earn less and have lower education
          • -----McCormick et al, 2006
health care costs of obesity in new zealand
HEALTH CARE COSTS OF OBESITY IN NEW ZEALAND
  • ANALYSIS USING SAME ILLNESSES (NIDDM, CHD, HTN, GALLSTONE DISEASE, BREAST AND COLON CANCER)
    • NZ$135MILLION OR 2.5% OF TOTAL HEALTH CARE COSTS 1991
          • ----Swinburn et al., 1997
slide10

STUDIES USING POPULATION ATTRIBUTABLE FRACTIONSPAF = PRODUCT OF RELATIVE RISK AND PREVALENCE RISK FACTORTHE PAF CAN BE USED TO CACULATE THE DIRECT COST OF TREATING OBESITY

studies utilizing population attributable fractions
STUDIES UTILIZING POPULATION ATTRIBUTABLE FRACTIONS
  • PAF CAN BE CALCULATED TO ESTIMATE DIRECT COST OF TREATING co-morbidities
    • Segal et al., 1994 (Australia) $A395 million
    • Levy et al., 1995 (France, 1990) FFr12 billion or 2% of the French health care costs
    • Seidell, 1995 (Netherlands) overweigt and obesity account for 4% of the total Dutch health care costs
          • ---Hughes and McGuire, 1997
body mass and health care expenditures
BODY MASS AND HEALTH CARE EXPENDITURES
  • MEDSTAT STUDY OF 16,217 INDIVIDUALS, 18-65
  • NATIONAL MEDICAL EXPENDITURE SURVEY DATA
    • USE OF ANY HEALTH CAR SERVICE AND EXPENDITURES
    • USE OF INPATIENT SERVICES AND EXPENDITURES
    • USE OF OUTPATIENT SERVICES AND EXPENDITURES
    • USE OF PRESCRIPTION MEDS AND EXPENDITURES
          • ---Heithoff et al., 1997
slide14
STRONG RELATIONSHIPS BETWEEN BODY MASS AND THE LIKELIHOOD OF USING HEALTH CARE SERVICES AND EXPENDITURES
  • ASSOCIATION WAS GREATER AMONG MALES
  • IDEAL BODY MASS WAS ASSOCIATED WITH 6.3% TO 36.1% LOWER ANNUAL HEALTH CARE EXPENDITURES (FEMALES) AND 3.6 TO 18.2% LOWERE EXPENDITURES IN MALES

---Heithoff et al, 1997

conclusion
CONCLUSION
  • Health care expenditures increase as weight deviates from the ideal
  • Increased expenditures and BMI relates to association of body mass to chronic illness especially diabetes and HTN

---Heithoff et al, 1997

impact of obesity and overweight in japan
IMPACT OF OBESITY AND OVERWEIGHT IN JAPAN
  • U-SHAPED ASSOCIATION BETWEEN BMI AND TOTAL MEDICAL COSTS
  • MEAN TOTAL COSTS WERE 9.8% GREATER AMONG THE OVERWEIGHT
  • STATISTICALLY INCREASED MORTALITY RISK IN OBESE WOMEN AND LEAN MEN AND WOMEN
  • STATISTICALLY SIG RELATIONSHIP BETWEEN EXCESS WEIGHT AND INCREASED RISK IN WOMEN OF ALL CANCERS
          • ----Kuriyama, et al., 2006
health care costs of obesity in new zealand1
HEALTH CARE COSTS OF OBESITY IN NEW ZEALAND
  • ANALYSIS USING SAME ILLNESSES (NIDDM, CHD, HTN, GALLSTONE DISEASE, BREAST AND COLON CANCER)
    • NZ$135MILLION OR 2.5% OF TOTAL HEALTH CARE COSTS 1991
          • ----Swinburn et al., 1997
indirect costs
INDIRECT COSTS
  • Colditz --indirect cost from lost productivity $20 billion for US in 1986 and $23 billion in updated study
  • Sjostrom et al., 1992--- level of sicknees absence was 1.4-2.4 times higher in obese individuals and number on disability pension 1.5-2.8 times higher (survey data)
  • Whole Swedish population--- 7% total productivity loss due to obesity
          • -----Hughes and McGuire, 1997
cost of obesity model
COST OF OBESITY MODEL
  • PATIENT CHARACTERISTICS (AGE, SEX, BMI)
      • Stage 1
  • CARDIOVASCULAR RISK PROFILE (HTN, HYPERCHOLESTEROLEMIA, TYPE II DIABETES)---management ($)
      • Stage 2
  • CARDIOVASCULAR DISEASE (CHD, STROKE)

----treatment of CHD, STROKE($)

---Thompson et al., 1999

inflation adjusted obesity attributable increase in per capita health care spending 1987 2001
Inflation-Adjusted Obesity Attributable Increase in Per Capita Health Care Spending1987-2001
  • Obesity accounted for 27 percent of the growth in real per capita spending between 1987 and 2001
  • Prevalence of obesity increased by 10.3 percentage points—to nearly 24 percent of the adult population
  • Costs incurred by obese were 37 percent higher than costs for those with normal weight
          • ---Thorpe, et al., 2004
health expenditures in overweight and obese children
HEALTH EXPENDITURES IN OVERWEIGHT AND OBESE CHILDREN
  • Retrospective study
  • Used claims data from a large pediatric delivery system
  • Urban academic children’s hospital
  • Outcome measures: Dx obesity, primary care visits, ER, lab use, health care charges

---Hampl, et al, 2007

health expenditures in overweight and obese children continued
HEALTH EXPENDITURES IN OVERWEIGHT AND OBESE CHILDREN (continued)
  • Overweight and obese children and adolescents have significantly more lab eval and higher charges
global epidemics of obesity and diabetes
GLOBAL EPIDEMICS OF OBESITY AND DIABETES
  • 7 OF 10 OF THE COUNTRIES WITH THE GREATEST NUMBER OF DIABETICS ARE IN THE GLOBAL SOUTH
  • WITHIN THE NEXT TWO DECADES, THE NUMBER OF PESONS LIIVING WITH DIABETES IN BRAZIL, CHINA AND INDIA IS PROJECTED TO INCREASE AT NEARLY TWICE THE RATE OBSERVED IN THE US
  • GREATER INCIDENCE AT EARLIER STAGES OF LIFE
  • NEARLY ONE OUT OF EVERY THREE HOSPITAL BED-DAYS IN LATIN AMERICA ARE OCCUPIED FOR DIABETES-RELATED CAUSES
          • ---Yach, Stuckler and Brownell, 2006
global epidemics of obesity and diabetes continued
GLOBAL EPIDEMICS OF OBESITY AND DIABETES (continued)
  • Diabetics in India: 15-25% of household income is required to cover treatment costs
  • Tanzania: costs amount to 25% of minimum wage or 20 times the per capita health expenditure
  • China: 30% of poor households attributed their poverty to healthcare costs

---Yach, Stuckler and Brownell, 2006

discussion of limitations of cost of illness studies
DISCUSSION OF LIMITATIONS OF COST-OF-ILLNESS STUDIES
  • “Economics and Obesity: Costing the Problem or Evaluating Solutions”
      • Larissa Roux and Cam Donaldson

Obesity Research v 12 no. 2 February 2004

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