Health benefits and evaluation of healthcare cost savings if oils rich in monounsaturated fatty acids were substituted for conventional dietary oils in the United States.
OBJECTIVE: To assess the impact of wellness center attendance on weight loss and costs. METHODS: A retrospective analysis was conducted using employee data, administrative claims, and electronic health records. A total of 3199 employees enrolled for 4 years (2007 to 2010) were included. Attendance was categorized as follows: 1 to 60, 61 to 180, 181 to 360, and more than 360 visits. Weight loss was defined as moving to a lower body mass index category. Total costs included paid amounts for both medical and pharmacy services. RESULTS: Subjects with 181 to 360 and more than 360 visits were 46% (P = 0.05) and 72% (P = 0.01) more likely to have body mass index improvement compared with those with 1 to 60 visits. Compared with the mean annual cost of $13,267 for 1 to 60 visits, the mean for subjects with 61 to 180, 181 to 360, and more than 360 visits had significantly lower costs at $9538, $9332 and $8293, respectively (all P < 0.01). Higher attendance was associated with weight loss and significantly lower annual costs.
Author(s):
Abdullah, M. M., et al.
Year Published:
2017
Cost-effectiveness of Obesity Interventions: Will We Know It When We See It?
In this issue of Pediatrics, Quattrin et al1 present the results of a cost-effectiveness analysis of a family-based obesity treatment (FBT) program relative to an information-based control intervention (IC). The IC educated parents to encourage their children to have a weight loss goal of 0.5 to 1 lb per week. Parents then attended 16 group meetings; each meeting delivered dietary and/or physical activity advice. In between meetings, a health coach telephoned the parents to remind them to attend the meetings. The FBT group attended the same number of group meetings and received the same information. They also received education on parenting techniques both at the group sessions and during brief individual sessions with a health coach, at which time the health coach would also problem solve any concerns raised. Parents in FBT were further instructed to monitor their childrens weight and their own weight twice a week and received additional dietary (1500 and 1800 kilocalories per day for mothers and fathers, respectively), physical activity, and sedentary activity recommendations. Parents were also instructed to record food intake and activity for their children and themselves in a diary by crossing off icons detailing food groups and physical and sedentary activities undertaken.
Author(s):
Finkelstein, E. A.
Year Published:
2017
Health economics of insomnia treatments: The return on investment for a good night’s sleep.
Chronic insomnia is the most common sleep disorder among adults and is associated with a wide range of negative outcomes. This article reviews the economic consequences of the disorder and the cost effectiveness of insomnia treatments. First, the total costs of insomnia are reviewed; in aggregate these costs exceed $100 billion USD per year, with the majority being spent on indirect costs such as poorer workplace performance, increased health care utilization, and increased accident risk. Next, the deleterious impact of insomnia on quality of life and the impact of treatment on quality of life are briefly considered. Finally, ten published studies evaluating the cost effectiveness of both pharmacological and behavioral treatments for insomnia are reviewed in detail. A significant majority of studies reviewed found that the cost of treating primary and comorbid insomnia is less than the cost of not treating it. Treatments were generally found to be cost-effective using commonly employed standards, with treatment costs being recouped within 6-12 mo.
Author(s):
Wickwire, E. M., et al.
Year Published:
2016
Return on investment of public health interventions: a systematic review.
BACKGROUND: Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions. METHODS: We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries. RESULTS: We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5. CONCLUSIONS: This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.
Author(s):
Masters, R., et al.
Year Published:
2017
Cost-effectiveness of preventing weight gain and obesity: what we know and what we need to know.
The objective of this study was to show gaps and inconsistencies in selected literature on the cost-effectiveness of preventing weight gain and obesity and to set an agenda for future research. A review and qualitative analysis of the literature was carried out on the cost-effectiveness of preventing weight gain and obesity, with a primary focus on programs that influence health outcomes and directly change individual behavior through physical activity promotion (i.e., energy expenditure increase). A literature search reveals that computer simulation models on the lifetime cost of obese versus normal-weight persons show conflicting results. Studies on programs to promote physical activity as a means to prevent obesity also show varying cost-effectiveness ratios, with a key variable from a societal perspective being the cost of time required to exercise. In particular, this review found a need for more parsimonious simulation models and more information on the comparative cost-effectiveness of programs to prevent weight gain/obesity.
Author(s):
Gandjour, A.
Year Published:
2012
Determining the cost of obesity and its common comorbidities from a commercial claims database.
What is already known about this subject Obesity is highly prevalent and costly in the US. Obesity often leads to other comorbid conditions, including diabetes and hypertension. Obesity prevention efforts can reduce healthcare costs. What this study adds Obesity combined with other comorbidities significantly increases healthcare costs per patient visit. The combination of obesity and depression exacerbates costs. The most expensive series of chronic conditions in this study included obesity, diabetes, hypertension and depression. Our objectives were to determine payments made by commercial healthcare providers in the US for adults diagnosed with obesity, and those comorbid with any combination of selected chronic conditions. Using a commercial claims and encounters database (n = 3,562,717), we evaluated an adult study population that had at least one in-patient visit, outpatient visit or emergency department visit, and received a primary or secondary diagnosis of obesity. Persons were categorized by one or more comorbid diagnoses for diabetes mellitus, hypertension, depression or congestive heart failure. We adjusted for age and gender, and calculated the mean total net expenditures (in 2012, $US) for each combination of comorbid conditions based on individual visits to an in-patient, outpatient or emergency department setting. Among 50,717 claims with diagnosis of obesity, the mean net expenditure for in-patient and outpatient services was $ 1907 per patient per visit. Persons diagnosed with obesity and other comorbidities observed an increase in total net expenditures. Obesity and congestive heart failure observed the highest increase among single comorbidities at $ 5275. For persons with obesity and two other comorbidities, diabetes mellitus and depression was the highest at $ 15,226. The most expensive condition was obesity, diabetes mellitus, hypertension and depression at $ 15,733. Compared with average medical claims, persons diagnosed with obesity and other common chronic conditions experience significant increases in medical costs. These costs are often driven higher by time spent as in-patients. By controlling and reducing the prevalence of obesity, we may see significant decreases in medical expenditures.
Author(s):
Padula, W. V., et al.
Year Published:
2014
Cost and Health Care Utilization Implications of Bariatric Surgery Versus Intensive Lifestyle and Medical Intervention for Type 2 Diabetes.
OBJECTIVE: The aim of this study was to compare the cost and health care utilization of patients with obesity and type 2 diabetes mellitus (T2DM) randomized into either Roux-en-Y gastric bypass (RYGB) surgery or an intensive lifestyle and medical intervention (ILMI). METHODS: This analysis (N = 745) is based on 2-year follow-up of a small randomized controlled trial (RCT); adult patients with obesity and T2DM were recruited between 2011 and 2012 from Kaiser Permanente Washington. Comparisons were made for patients randomized into either RYGB (N = 15) or ILMI (N = 17). RESULTS: There were no significant cost savings for RYGB versus ILMI patients through the follow-up years. Pharmacy cost was lower for RYGB versus ILMI patients by about $900 in year 2 versus year 0; however, inpatient and emergency room costs were higher for surgery patients in follow-up years relative to year 0. Median total cost for nonrandomized patients was higher in year 0 and in year 2 compared to randomized patients. CONCLUSIONS: Bariatric surgery is not cost saving in the short term. Moreover, the costs of patients who enter into RCTs of RYGB may differ from the costs of those who do not enter RCTs, suggesting use of caution when using such data to draw inferences about the general population with obesity.
Author(s):
Banerjee, S., et al.
Year Published:
2017
Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce.
INTRODUCTION: Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). METHODS: We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). RESULTS: Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor-specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. CONCLUSION: Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages.
Author(s):
Asay, G. R., et al.
Year Published:
2016
Obesity Increases Risk-Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery.
BACKGROUND: Despite the epidemic rise in obesity, few studies have evaluated the effect of obesity on cost following cardiac surgery. We hypothesized that increasing body mass index (BMI) is associated with worse risk-adjusted outcomes and higher cost. METHODS AND RESULTS: Medical records for 13 637 consecutive patients who underwent coronary artery bypass grafting (9702), aortic (1535) or mitral (837) valve surgery, and combined valve-coronary artery bypass grafting (1663) procedures were extracted from a regional Society of Thoracic Surgeons certified database. Patients were stratified by BMI: normal to overweight (BMI 18.5-30), obese (BMI 30-40), and morbidly obese (BMI >40). Differences in outcomes and cost were compared between BMI strata and also modeled as a continuous function of BMI with adjustment for preoperative risk using Society of Thoracic Surgeons predictive risk indices. Morbidly obese patients incurred nearly 60% greater observed mortality than normal weight patients. Moreover, morbidly obese patients had greater than 2-fold increase in renal failure and 6.5-fold increase in deep sternal wound infection. After risk adjustment, a significant association was found between BMI and mortality (P<0.001) and major morbidity (P<0.001). The risk-adjusted odds ratio for mortality for morbidly obese patients was 1.57 (P=0.02) compared to normal patients. Importantly, risk-adjusted total hospital cost increased with BMI, with 17.2% higher costs in morbidly obese patients. CONCLUSIONS: Higher BMI is associated with increased mortality, major morbidity, and cost for hospital care. As such, BMI should be more strongly considered in risk assessment and resource allocation.
Author(s):
Ghanta, R. K., et al.
Year Published:
2017
Cohort analysis assessing medical and nonmedical cost associated with obesity in the workplace.
OBJECTIVE: Quantify the impact of employee overweight and obesity on costs, absence days, and self-reported productivity. METHODS: Employees' retrospective body mass index (BMI) values (kg/m(2)) from 2003 to 2011 health appraisal data defined three cohorts: BMI < 27, 27 /= 30. Medical, pharmacy, sick leave, short-term disability, long-term disability, and workers' compensation costs and absence days, and Health Productivity Questionnaire responses were compared using regression modeling, controlling for demographics, salary, and index year. RESULTS: Among 39,696 (BMI < 27), 14,281 (27 /= 30) eligible employees, per-employee adjusted total annual costs were $4258, $4873, and $6313, respectively. Medical, pharmacy, sick leave, workers' compensation costs and days were higher for higher-BMI cohorts (P < 0.01). Employees with BMI >/= 30 kg/m(2) had the most short-term disability costs and days and least productivity (P < 0.001). CONCLUSIONS: Employees with higher BMI levels are associated with significantly more costs and absences and lower self-reported productivity.
Author(s):
Kleinman, N., et al.
Year Published:
2014