Cost of Comorbidities in Obese Adults

San Diego—Using data from research databases, researchers confirmed that patients with a body mass index (BMI) ≥35 kg/m2 had a higher prevalence of and costs associated with comorbidities compared with patients who had a BMI between 25 and 34.9 kg/m2. They concluded health plans could reduce costs and lower patients’ BMI with therapies or disease management. Their findings were published at the ADA meeting in a poster titled Prevalence-Adjusted Cost of Comorbidities in Overweight/Obese Patients with a Body Mass Index 25-34.9 vs ≥35. The authors cited a recent National Health and Nutrition Examination Survey that estimated the overall age-adjusted prevalence of overweight (BMI 25-29.9 kg/m2) and obese (BMI ≥30 kg/m2) adults ≥20 years of age was 68.0%. In addition, 33.8% of patients were obese, and 14.3% were morbidly obese (BMI ≥35 kg/m2). They also mentioned research has shown overweight and obese adults are at an increased prevalence of comorbidities such as diabetes, kidney disease, hypertension, metabolic syndrome, and chronic back pain. In this study, the authors used the General Electrical Centricity Electronic Medical Record (GE EMR) and the MedStat MarketScan Commercial Claims and Encounters (CCE) databases to determine the comorbidities found in overweight and obese adults and to estimate the costs associated with the comorbidities. Inclusion criteria included age between 20 and 64 years on the date of the most recently recorded BMI; a recorded BMI ≥25 kg/m2 between March 1, 2005, and June 30, 2009; and 2 years of preindex date activity. The authors identified comorbidities by analyzing the GE EMR, which contains ambulatory care electronic health data for 15 million patients obtained from 15,000 providers in 35 states. They used the MedStat MarketScan CCE database to determine the costs of 25 comorbidities. The authors said that the comorbidity rates were similar in the GE EMR and MedStat MarketScan CCE databases. The authors identified 109,885 eligible patients from the GE EMR database: 85,984 had a BMI between 25 and 34.9 kg/m2 and 23,901 had a BMI ≥35 kg/m2. They also identified 246,261 patients from the MedStat MarketScan CCE database. The following 10 comorbidities were the most prevalent: hyperlipidemia (14.6% of the lower BMI group and 16.3% of the higher BMI group); hypertension (10.2% of the lower BMI group and 17.7% of the higher BMI group); chronic back pain (7.5% of the lower BMI group and 8.3% of the higher BMI group); diabetes (2.8% of the lower BMI group and 8.3% of the higher BMI group); coronary artery disease (1.3% of the lower BMI group and 2.0% of the higher BMI group); sleep apnea (1.3% of the lower BMI group and 4.6% of the higher BMI group); hip pain (1.0% of the lower BMI group and 1.1% of the higher BMI group); knee osteoarthritis (0.4% of the lower BMI group and 1.0% of the higher BMI group); nonalcoholic steatohepatitis (0.4% of the lower BMI group and 0.8% of the higher BMI group); and asthma (0.3% of the lower BMI group and 0.4% of the higher BMI group). Of the 25 comorbidities in the study, 21 were associated with higher costs in the higher BMI group. The largest difference was found with diabetes. For a health plan with 1000 members, diabetes-associated costs were estimated at $323,000 for patients with a BMI ≥35 kg/m2 and $110,000 for patients with a BMI between 25 and 34.9 kg/m2. Costs were also considerably higher in the group with a BMI ≥35 kg/m2 compared with the group with a BMI between 25 and 34.9 kg/m2 for heart failure ($241,000 vs $70,000), knee osteoarthritis ($195,000 vs $78,000), hypertension ($268,000 vs $154,000), sleep apnea ($125,000 vs $35,000), and coronary artery disease ($278,000 vs $190,000). Costs were lower in the group with a BMI ≥35 kg/m2 compared with the group with a BMI between 25 and 34.9 kg/m2 for ($2000 vs $3000), cerebrovascular disease ($28,000 vs $31,000), esophageal cancer ($0 vs $3000), and breast cancer ($60,000 vs $66,000). This study was sponsored by Takeda Pharmaceuticals International, Inc.