Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status
Savings in Medical Expenditures Associated with Reductions in Body Mass Index Among US Adults with Obesity, by Diabetes Status
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DOI：
10.1007/s40273-014-0230-2
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发表时间：
2015-07-01
影响因子：
4.4
通讯作者：
Wintfeld, Neil
中科院分区：
文献类型：
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作者：
Cawley, John;Meyerhoefer, Chad;Wintfeld, Neil
在过去的30年里，美国肥胖症的患病率增加了一倍多。肥胖是糖尿病、心血管疾病和其他临床显著共病的显著风险因素。本文估计了具有不同体重指数（BMI）起始值的人在一定量的体重减轻中可以节省的医疗费用，对于那些患有糖尿病和没有糖尿病的人。这些信息是肥胖治疗和预防计划成本效益分析的重要输入。使用2000-2010年医疗支出小组调查（MEPS）的数据估计工具变量的两部分模型。对所有成年人以及分别对患有和不患有糖尿病的人进行模型估计。我们计算了BMI变化对医疗保健支出的因果影响，以及BMI特定变化的成本节省（5，10，15和20%）从起始BMI水平范围从30至45 kg/m2（2），以及肥胖引起的总超额医疗费用。在美国，成人肥胖使每个肥胖个体的年度医疗费用增加了3,508美元，全国总额为3158亿美元（2010年价值）。然而，医疗保健费用与BMI的关系是J形的;在2级和3级肥胖范围内，费用呈指数上升（BMI为千分之一35）。肥胖者体重越重，BMI降低一定百分比所带来的医疗费用减少越多。糖尿病患者的医疗费用比非糖尿病患者高，且随着BMI的增加而增加，体重越重的肥胖患者，BMI降低一定比例所节省的医疗费用越多，糖尿病患者比非糖尿病患者节省的医疗费用更多。研究结果为健康保险公司、雇主、政府机构和健康经济学家提供了对减肥导致的医疗支出变化的准确估计，这是计算预防和治疗肥胖干预措施的成本效益的重要信息。
The prevalence of obesity has more than doubled in the USA in the past 30 years. Obesity is a significant risk factor for diabetes, cardiovascular disease, and other clinically significant co-morbidities. This paper estimates the medical care cost savings that can be achieved from a given amount of weight loss by people with different starting values of body mass index (BMI), for those with and without diabetes. This information is an important input into analyses of the cost effectiveness of obesity treatments and prevention programs.Two-part models of instrumental variables were estimated using data from the Medical Expenditure Panel Survey (MEPS) for 2000-2010. Models were estimated for all adults as well as separately for those with and without diabetes. We calculated the causal impact of changes in BMI on medical care expenditures, cost savings for specific changes in BMI (5, 10, 15, and 20 %) from starting BMI levels ranging from 30 to 45 kg/m(2), as well as the total excess medical care expenditures caused by obesity.In the USA, adult obesity raised annual medical care costs by $US3,508 per obese individual, for a nationwide total of $US315.8 billion (year 2010 values). However, the relationship of medical care costs over BMI is J-shaped; costs rise exponentially in the range of class 2 and 3 obesity (BMI a parts per thousand yen35). The heavier the obese individual, the greater the reduction in medical care costs associated with a given percent reduction in BMI. Medical care expenditures are higher, and rise more with BMI, among individuals with diabetes than among those without diabetes.The savings from a given percent reduction in BMI are greater the heavier the obese individual, and are greater for those with diabetes than for those without diabetes. The results provide health insurers, employers, government agencies, and health economists with accurate estimates of the change in medical care expenditures resulting from weight loss, which is important information for calculating the cost effectiveness of interventions to prevent and treat obesity.