Association of obesity with healthcare resource utilization and costs in a commercial population

Abstract

Objective: To examine the association of obesity with healthcare resource utilization (HRU) and costs among commercially insured individuals.

Methods: This retrospective observational cohort study used administrative claims from 1 January 2007 to 1 December 2013. The ICD-9-CM status codes (V85 hierarchy) from 2008 to 2012 classified body mass index (BMI) into the World Health Organizations’ BMI categories. The date of first observed BMI code was defined as the index date and continuous eligibility for one year pre- and post- index date was ensured. Post-index claims determined individuals’ HRU and costs. Sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data ensured representation of the US adult commercially insured population. Baseline characteristics were described across BMI classes and associations between BMI categories, and outcomes were examined using multivariable regression.

Results: The cohort included 9651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%) and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department and outpatient utilization, and higher total healthcare, medical and pharmacy costs.

Conclusions: Increasing BMI was associated with higher prevalence of cardiometabolic conditions and higher HRU and costs. There is an urgent need to address the epidemic of obesity and its clinical and economic impacts.

Keywords:

• Obesity
• body mass index
• healthcare utilization
• healthcare costs

Transparency

Declaration of funding

This paper was funded by Novo Nordisk Inc.

Author contributions: All authors were involved with the conception, design and interpretation of results. P.S.K. was primarily responsible for data analysis and led the initial draft of the manuscript. All authors have reviewed and participated in subsequent revisions and approved the final version of the manuscript.

Declaration of financial/other relationships

P.S.K., J.H., J.C., R.A.H. and B.S. have disclosed that they are employees of Comprehensive Health Insights Inc., a subsidiary of Humana Inc., which received funding from Novo Nordisk Inc. to conduct this study. M.H. has disclosed that she is an employee of Novo Nordisk Inc., and owns stock in the company. J.H. and J.B. have disclosed that they were employees of Novo Nordisk Inc. at the time the study was conducted. A.R. has disclosed that he is an employee of Humana Inc.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

We would like to thank Dr. Mary Costantino PhD at Comprehensive Health Insights for her editorial contributions to this work.