The medical cost of cardiometabolic risk factor clusters in the United States.
OBJECTIVE
Diabetes, hypertension, hyperlipidemia, and overweight/obesity often cluster together. The prevalence of these cardiometabolic risk factor clusters (CMRFCs) is increasing significantly for all sociodemographic groups, but little is known about their economic impact.


METHODS
The nationally representative Medical Expenditure Panel Survey was used (2000 and 2002). The current study estimated the national cost of CMRFCs independent of the cost of cardiovascular disease in the U.S., as well as the cost for all major payers and the marginal cost per individual using a Heckman selection model with Smearing retransformation. CMRFCs included BMI >or= 25 and two of the following three: diabetes, hyperlipidemia, and/or hypertension. All amounts are expressed in 2005 U.S. dollars.


RESULTS
National medical expenditures attributable to CMRFCs in the U.S. totaled 80 billion dollars, of which 27 billion dollars was spent on prescription drugs. Private insurance paid the largest amount of the national bill (28 billion dollars), followed by Medicare (11 billion dollars), Medicaid (6 billion dollars), and the Veterans Administration (4 billion dollars), whereas individuals paid 28 billion dollars out-of-pocket. For each individual with CMRFCs, 5477 dollars in medical expenditures was attributable to CMRFCs, of which 1832 dollars was for prescription drugs. On average, individuals with CMRFCs spent 1668 dollars out-of-pocket, of which 830 dollars was for prescription drugs.


CONCLUSIONS
The results of this study show that CMRFCs result in significant medical cost in the U.S. independent of the cost of cardiovascular disease. Individuals, private insurers, Medicare, Medicaid, the Veterans Administration, and other payers all share this burden.
Sullivan
Patrick W
PW
Pharmaceuticals Outcomes Research Program, University of Colorado at Denver Health Sciences Center, 4200 East Ninth Avenue, C238, Denver, CO 80262, USA. patrick.sullivan@uchsc.edu
Ghushchyan
Vahram
V
Wyatt
Holly R
HR
Hill
James O
JO
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D016000:Cluster Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000191:economics / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000191:economics / Q000453:epidemiology; D007348:Insurance, Health / Q000191:economics; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000191:economics* / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000191:economics / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology