Transcript Economic-Implications-of-Obesity

Economic Implications of Obesity
Management
Economic Consequences of Obesity
Why 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
Economic Burden of Obesity - Similar
to Other Chronic Diseases
Direct cost of chronic diseases in the U.S. ($2003)
Billions, $
Obesity 1
Type 2 Diabetes* 2
Coronary heart disease 3
Hypertension 4
Arthritis 5
Breast Cancer 6
1 Finkelstein
75.0
73.7
52.4
28.2
23.9
7.1
EA, Obes Res 2004;12, 4. Hodgson TA et al. Med Care 2001;39:599, 2 ADA Diabetes Care,
2003;26:917, 5 Yelin & Callahan. Arthritis Rheum 1995;38:1351, 3 Hodgeson TA et al. Medical Care
1999:37:994. 5 Brown ML, et al. Medical Care; 2002;40(suppl): IV-104, Courtesy of Anne Wolf, MS, RD.
Obesity Contribution to Health Care
Costs
Direct
Cost
($ billions)
Indirect
Cost
($ billions)
Total Cost
Of Condition
($ billions)
Attributable
to Excess
Weight (%)
Type 2 Diabetes
$32.4
$30.74
$63.14
61
Heart Disease
$6.99
$33.41
$40.4
17
Hypertension
$3.23
$15.77
$19
17
Osteoarthritis
$4.3
$12.9
$17.2
24
Colon Cancer
$1
$1.78
$2.78
11
Breast Cancer
$.840
$1.48
$2.32
11
Endometrial Cancer
$.286
$.504
$.790
34
Comorbid
Condition
Wolf AM, Colditz GA. Obes Res. 1998;6:97.
Estimated Obesity-Attributable % U.S. Business
Health Care Spending on Selected Diseases
100
Mild Obesity
85.5%
Moderate-to-Severe Obesity
80
60
27.0%
46.8%
46.0%
40
36.2%
18.7%
20
19.0%
15.9%
0
Hy pertension
Hy percholesterolemia
Ty pe 2 Diabetes
Coronary Heart
Stroke
Gallbladder Disease Endometrial Cancere Osteoarthritis of Knee
Disease
Thompson D, Edelsberg J, Kinsey K, Oster G, et al. Estimated Economic Costs of Obesity to U.S.
Business. Am J Health Promot 1998: 13(2): 120-127.
Health Care costs of Obesity
Costs Stratified by BMI
BMI Range
25-30 kg/m2
30-35 kg/m2
> 35 kg/m2
P Value
Inpatient days
0.83
1.33
1.70
< 0.001
Inpatient cost
0.83
1.33
1.70
Outpatient visits
1.02
1.14
1.25
< 0.001
< 0.001
Outpatient cost
0.99
1.21
1.37
< 0.001
Pharmacy cost
1.23
1.60
1.78
< 0.001
Lab cost
0.97
1.24
1.85
Cost: Total care
0.95
1.25
1.44
< 0.001
< 0.001
Variable
BMI = body mass index. Rate ratio reference group is BMI 20-25 kg/m2. P value represents
association between BMI and cost or utilization specified.
Am J of Manage Care, March 1998.
Obesity Effect on Expected Lifetime
Medical Care Costs* in Men
Costs ($)*
40000
30000
20000
10000
0
37.5
32.5
27.5
22.5
Body Mass Index (kg/m2)
55-64
45-54
Age
35-44
(y)
*Total cost of CHD, type 2 DM, hypertension, hypercholesterolemia, stroke
Thompson et al. Arch Intern Med 1999;159:2177.
Obesity Effect on Expected Lifetime
Medical Care Costs in Women
Costs ($)
40,000
30,000
20,000
55 - 64
45 - 54
Age
35 - 44
10,000
0
37.5
32.5
27.5
BMI (kg/m2)
22.5
*Total cost of 8 diseases: CHD, type 2 DM, hypertension, hypercholesterolemia, stroke,
gallbladder disease, osteoarthritis of knee, endometrial cancer.
Adapted from Thompson D et al. Arch Intern Med 1999;2177-2183.
Expected Lifetime Medical Care* Savings
of Sustained 10% Weight Loss by
Age and Initial BMI (Women)
6000
Costs ($)
5000
4000
3000
55 - 64
2000
45 - 54
1000
35 - 44
0
37.5
32.5
BMI (kg/m2)
Age
27.5
*Total cost of 5 diseases: CHD, type 2 DM, hypertension, hypercholesterolemia, and stroke.
Adapted from Oster G, et al. Am J Public Health 1999;89:1536-1542.
Medical Resource Use for Obese,
Nonobese Patients - 1Year Data
Obese Patients
(n = 539)
Item, $
Total
Outpatient visits
51759
Hospitalizations
81992
Professional
service claims
Prescription
drugs
Total costs
102444
337973
574167
Median
(5th - 95th
Percentile)
79.58
(0 - 227.25)
0
(0 - 0)
0
(0 - 1151.26)
357.65
(0 - 2061.11)
585.44
(51.11 - 4137.41)
Nonobese Pts
(n = 1225)
Total
174507
73018
172698
447998
868221
Median
(5th - 95th
Percentile)
91.82
(0 - 489.71)
0
(0 - 0)
0
(0 - 764.50)
157.86
(0 - 1361.27)
333.24
(0 - 2431.73)
*Two-part regression model (Berk and Lachenbruch 2002)
Raebel, M. et al. Arch Intern Med 2004;19(164):2135-2140.
P Value*
< 0.001
0.01
0.20
< 0.001
< 0.001
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 2004;19(164):2135-2140.
Increase in Cost Compared
with Lean Subjects (%)
Increase Healthcare Costs - Obese
Compared with Lean
17,188 Patients-1 Year Data
100
Healthcare visits
Pharmacy
Laboratory tests
All outpatient services
All inpatient services
Total healthcare
80
60
40
20
0
BMI 30 - 34 kg/m2
BMI ≥ 35 kg/m2
*HMO Setting: Northern California Kaiser Permanente
Quesenberry CP Jr et al. Arch Intern Med. 1998;158:466-472.
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. 1999;28:;2235-2239.
Economic Effect of Obesity in Workplace
3-Year Costs to First Chicago NBD
Lean
$8,000
$6,822
Obese*
$1,546
$1,600
$1,200
$6,000
$4,496
$4,000
$800
$2,000
$400
$0
$0
Healthcare
$683
Absenteeism
*BMI > 27.8 kg/m2 in men; > 27.3 kg/m2 in women.
Burton et al. J Occup Environ Med 1998;40:786.
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.
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.
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.
Contribution to Total Cost of Primary
Medical Care California, Year 20002,579,444 Adults
Risk Factor
1999 Direct
Medical
Care Cost
% of Total Cost
Mid-2000
of Primary
Inflator 2000 Costs Medical Care
Physical
Inactivity
$233,757,324
x 1.0352
$241,985,581
3.92%
Obesity
$130,912,520
x 1.0352
$135,520,641
2.19%
Overweight
$90,329,639
x 1.0352
$93,509,242
1.51%
$471,015,464
7.62%
$454,999,483
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.
Obesity in the Short term
Increases Health Care Costs
Obesity Wage Differentials
10
8
6
4
Wage
2
Wage for Obese
Wage for Nonobese
0
1981
1982
1985
1986
1987
1898
1990
Baum C, Ford W. Health Economics. 2004;13:885-899.
1992
1993
1994
1996
1998
Obesity Wage Differential by Gender
12
10
8
6
4
Obese Male Wage
Nonobese Male Wage
2
Obese Female Wage
Nonobese Femal Wage
0
1981
1982
1985
1986
1987
1898
1990
Baum C, Ford W. Health Economics. 2004. 13:885-899.
1992
1993
1994
1996
1998
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. 1991;156[2]:76-82.
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 2002;167(5):393-397.
9 Year Total Healthcare Costs
Thompson, D. et al. Obes Res. 2001;9(3):210-218.
9 Year Costs of Prescription Drugs
Thompson, D. et al. Obes Res. 2001;9(3):210-218.
9 Year Costs of Outpatient Services
Thompson, D. et al. Obes Res. 2001;9(3):210-218.
Cost Increases Associated with
Obesity and 20 Years Aging 1998
Percent Change
100
Obese
20 years’ aging*
80
Smoking (current)
60
Overweight
40
Problem drinking
20
Smoking (past)
0
Services
Medication
Sources: Author’s 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.
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.
Medicare Charges Age 65 Years
to Death or Age 83 Years (1984 – 2002),
by Baseline BMI (1967 – 1973)
Charges
BMI 18.5 – 24.9
BMI 25.0 – 29.9
BMI 30.0 – 34.9
BMI ≥ 35.0
Men (n = 2616)
No.
Death, No. (%)
CVD
Diabetes
Total
662
395 (59.7)
26567
167
100431
1427
835 (58.5)
36159ŧ
832ŧ
109098§
457
303 (66.3)
43168ŧ
1047ŧ
119318§
70
58 (82.9)
58380ŧ
6284ŧ
176947ŧ
Women (n = 2616)
No.
Death, No. (%)
CVD
Diabetes
Total
1187
490 (41.3)
17566
211
76866
622
253 (40.7)
30324 §
853ŧ
100959
169
87 (51.5)
36166ŧ
2325ŧ
125470§
78
49 (62.8)
47000ŧ
10783ŧ
174752ŧ
*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 < 0.001 for trend across 4 BMI Groups based on BMI as a continuous variable entered in a modified Cox
regression model.
ŧp < 0.001 for comparisons with 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. 2004;292(22):2743-2749.
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.22:2743-2749.
Difference in Cost in Severely Obese
• 84% higher total difference in charges –
severely obese vs non-overweight men
• 88% higher total difference in chargesseverely obese vs non-overweight women
Daviglus. M. et al. JAMA. 2004;Vol.292, No.22:2743-2749.
• 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.
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.
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. 1999;7:523-531.
Weight Management for Diabetes,
Hypertension,
and Dyslipidemia - Saves Money
Savings/
Month
% Loss
From Initial
Weight
Diabetes (insulin RX)
$104
7%
Diabetes (sulfonylurea Rx)
$55
7%
Hypertension
$20
10%
Dyslipidemia
$61
5%
Obesity
Comorbidity
Greenway FL, Ryan DH, Bray GA. Obesity Research. 1999;7:523-531.
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.
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.
Five Keys
1. Obesity is a serious problem.
2. Risk assessment drives treatment options.
3. Modest weight loss = Major health benefits.
4. Lifestyle is the foundation of treatment.
5. PCP’s have special role:
– Promote lifestyle for all patients.
– Help patients with weight loss, including prescribing
and referral for surgery.
Weight Loss
and IWQOL-Lite Scores
1-Year IWOOL-Lite Per-Item Change +/- SE
-0.0
Physical
Function
SelfEsteem
Sexual
Life
Public
Distress
Work
IWQOL-Lite
Total
-0.1
-0.2
-0.3
-0.4
-0.5
-0.6
-0.7
-0.8
< 10% Weight Loss
10% - 14.9% Weight Loss
-0.9
-1.0
-1.1
Kolokin, R. et al. Obesity Research. 2001.
15% - 19.9% Weight Loss
20% + Weight Loss
Effect of Obesity and 20 Years Aging
on Chronic Medical Conditions and
Health-Related Quality of Life, 1998
Obese
2.0
20 years’ aging*
1.5
Smoking (current)
Overweight
1.0
Problem drinking
0.5
Smoking (past)
0.0
Increase in number of
chronic conditions
Decline in healthrelated quality of life
(0 - 100 scale)
Sources: Author’s 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.