title: Weight loss and lifetime medical expenditures: a case study with TRICARE prime beneficiaries.
abstract: BACKGROUND
  TRICARE's Prime (managed care) plan spends more than $1 billion annually in medical expenditures attributed to overweight and obesity.
  
  
  OBJECTIVE
  This study estimates change in lifetime disease prevalence and medical expenditures associated with weight loss for beneficiaries in TRICARE's Prime plan.
  
  
  METHODS
  This 2010 analysis uses Markov Chain Monte Carlo simulation with demographics, biometrics, health behavior, and disease presence for 857,200 overweight and 521,800 obese beneficiaries aged 18-64 years in 2008 to model future onset of diseases linked to excess weight. Prediction equations in the simulation come from multiple sources: (1) regression analysis with longitudinal (2007-2008) TRICARE medical claims and electronic health records for 2.1 million beneficiaries; (2) regression analysis with Medical Expenditure Panel Survey (2002-2007) and National Health and Nutrition Examination Survey (1999-2008) data; (3) cancer and mortality risk from Surveillance, Epidemiology, and End Results data; and (4) published findings from clinical trials.
  
  
  RESULTS
  Among overweight and obese beneficiaries, lifetime medical expenditures declined $440 (3% discount rate) for each permanent 1% reduction in body weight. This includes $590 in savings from improved health, offset by $150 in additional expenditures from prolonged life. Estimates range from $660 reduction for grossly obese adults aged <45 years to $40 gain from grossly obese adults aged 55-64 years (where expenditures from increased longevity exceed savings from improved health). If weight loss is temporary and regained after 24 months, lifetime expenditures decline by $40 per 1% reduction in body weight.
  
  
  CONCLUSIONS
  Long-term benefits from weight loss are substantially greater than short-term benefits, underscoring the need for a societal perspective to combat obesity.
authors.affiliation: The Lewin Group, Falls Church, Virginia, USA. tim.dall@ihs.com
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Dall
authors.forename: Yiduo
authors.initials: Y
authors.lastname: Zhang
authors.forename: Shiping
authors.initials: S
authors.lastname: Zhang
authors.forename: David R
authors.initials: DR
authors.lastname: Arday
authors.forename: Navita
authors.initials: N
authors.lastname: Sahai
authors.forename: Patricia
authors.initials: P
authors.lastname: Dorn
authors.forename: Anjali
authors.initials: A
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000328:Adult; D057286:Electronic Health Records; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008390:Markov Chains; D008875:Middle Aged; D009010:Monte Carlo Method; D009765:Obesity / Q000191:economics* / Q000453:epidemiology; D050177:Overweight / Q000191:economics* / Q000453:epidemiology; D012044:Regression Analysis; D018426:SEER Program; D013997:Time Factors; D015431:Weight Loss; D055815:Young Adult