title: Healthcare costs and obesity prevention: drug costs and other sector-specific consequences.
abstract: BACKGROUND
  Obesity is a major contributor to the overall burden of disease (also reducing life expectancy) and associated with high medical costs due to obesity-related diseases. However, obesity prevention, while reducing obesity-related morbidity and mortality, may not result in overall healthcare cost savings because of additional costs in life-years gained. Sector-specific financial consequences of preventing obesity are less well documented, for pharmaceutical spending as well as for other healthcare segments.
  
  
  OBJECTIVE
  To estimate the effect of obesity prevention on annual and lifetime drug spending as well as other sector-specific expenditures, i.e. the hospital segment, long-term care segment and primary healthcare.
  
  
  METHODS
  The RIVM (Dutch National Institute for Public Health and the Environment) Chronic Disease Model and Dutch cost of illness data were used to simulate, using a Markov-type model approach, the lifetime expenditures in the pharmaceutical segment and three other healthcare segments for a hypothetical cohort of obese (body mass index [BMI] >or=30 kg/m2), non-smoking people with a starting age of 20 years. In order to assess the sector-specific consequences of obesity prevention, these costs were compared with the costs of two other similar cohorts, i.e. a 'healthy-living' cohort (non-smoking and a BMI >or=18.5 and <25 kg/m2) and a smoking cohort. To assert whether preventing obesity results in cost savings in any of the segments, net present values were estimated using different discount rates. Sensitivity analyses were conducted across key input values and using a broader definition of healthcare.
  
  
  RESULTS
  Lifetime drug expenditures are higher for obese people than for 'healthy-living' people, despite shorter life expectancy for the obese. Obesity prevention results in savings on drugs for obesity-related diseases until the age of 74 years, which outweigh additional drug costs for diseases unrelated to obesity in life-years gained. Furthermore, obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Discounting costs more heavily or using lower relative mortality risks for obesity would make obesity prevention a relatively more attractive strategy in terms of healthcare costs, especially for the long-term care segment. Application of a broader definition of healthcare costs has the opposite effect.
  
  
  CONCLUSIONS
  Obesity prevention will likely result in savings in the pharmaceutical segment, but substantial additional costs for long-term care. These are important considerations for policy makers concerned with the future sustainability of the healthcare system.
authors.affiliation: Erasmus University Medical Centre, Department of Health Policy & Management and Institute for Medical Technology Assessment, Rotterdam, the Netherlands. rappange@bmg.eur.nl
authors.forename: David R
authors.initials: DR
authors.lastname: Rappange
authors.forename: Werner B F
authors.initials: WB
authors.lastname: Brouwer
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Hoogenveen
authors.forename: Pieter H M
authors.initials: PH
authors.lastname: Van Baal
mesh_terms: D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000706:statistics & numerical data* / Q000639:trends; D017048:Health Care Costs / Q000706:statistics & numerical data / Q000639:trends; D015276:Health Care Rationing / Q000191:economics* / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends; D006295:Health Resources / Q000191:economics* / Q000639:trends; D006801:Humans; D008390:Markov Chains; D017059:Models, Econometric; D009426:Netherlands; D009765:Obesity / Q000150:complications / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years