Association of obesity with healthcare utilization and costs in a Medicare population

Abstract

Objectives: To examine the association of obesity with healthcare resource utilization and costs in a Medicare population.

Methods: This study was a retrospective cohort study using Humana Medicare Advantage (MA) claims data. Body mass index (BMI) was assessed using ICD-9-CM status codes (V85 hierarchy) that have been validated in the data source to classify patients into BMI categories: normal (N), overweight (Ow), obese class I (ObI), obese class II (ObII), and obese class III (ObIII). Healthcare resource utilization (HRU) and costs were determined based on claims data. Descriptive statistics were used to examine baseline characteristics and HRU across BMI classes. Multivariable analysis was used to examine the association between BMI class and outcome measures.

Results: Among the 172,866 patients aged ≥65 years that were identified, BMI distribution was: N, 21%; Ow 37%; ObI, 24%, ObII, 10%; and ObIII, 9%. Inpatient, emergency department and outpatient utilization increased with greater BMI level, and greater BMI level was associated with higher total healthcare, medical and pharmacy costs. Greater prevalence of several cardiometabolic conditions, total medication use, and use of specific medication classes was observed with increasing BMI class.

Conclusions: Greater BMI was associated with greater HRU and costs and observed increase in prevalence of cardiometabolic conditions. These results reflect an urgent need to address the epidemic of obesity and the resulting excessive clinical and economic burden on the healthcare system.

Keywords:

• Obesity
• healthcare resource utilization
• costs
• Medicare

Transparency

Declaration of funding

This study was sponsored by Novo Nordisk. The research was conducted as part of the Humana–Novo Nordisk research collaboration and was approved by the Joint Research Governance committee, consisting of employees of Novo Nordisk, Humana, and Comprehensive Health Insights. This manuscript was drafted by employees of Comprehensive Health Insights, and employees of Novo Nordisk and Humana provided critical review and feedback to the content.

Author contributions: B.T.S., P.K., A.R., J.H., M.H., and J.B. contributed to study conception and design. P.K. and B.T.S. contributed to analysis of the data. B.T.S., P.K., A.R., J.H., M.H., J.B. and M.E.C. contributed to interpretation of the data. M.E.C. and B.T.S. drafted the manuscript, and P.K., A.R., J.H., M.H., and J.B. provided critical review and feedback to the content. All authors have approved the final version of the manuscript to be published, and all authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

B.T.S., P.K., and M.E.C. have disclosed that they are employees of Comprehensive Health Insights, a wholly owned research subsidiary of Humana. A.R. has disclosed that he is an employee of Humana. B.T.S. has disclosed that he has stock ownership in Humana. J.H. and J.B. have disclosed that they were employees of Novo Nordisk at the time that this research was conducted. M.H. is an employe of Novo Nordisk. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Acknowledgements

Results of this research were previously presented in poster form at the 2015 Annual Meeting of the Endocrine Society, San Diego, CA, USA, 5 March 2015.