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Abstract
Background
Turkey currently has the highest obesity prevalence among its European counterparts. 32% and 61% of the population live with obesity and overweight, respectively. Overweight and obesity are linked to non-communicable diseases that incur incremental health and economic costs. The significant public health concern warrants an assessment of the cost of obesity.
Methods
A micro-costing approach from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Turkey. Clinical practice guidelines and a systematic literature review informed ORCs and the respective cost categories. This was subsequently validated by a steering committee comprising seven experts. Seventy public sector physicians were surveyed to estimate healthcare resource use. Unit costs were derived from Social Security Institute’s Healthcare Implementation Communique. Cost items were summed to determine the annual cost per patient per ORC, which was validated by the steering committee. Medical inflation was considered in a scenario analysis that varied resource unit costs.
Results
Chronic kidney disease, heart failure and type 2 diabetes are the costliest ORCs, incurring an annual cost of 28,600 TRY, 16,639 TRY and 11,993 TRY, respectively. Individuals in Turkey with any ORC triggered direct healthcare costs ranging 1857–28,600 TRY annually. Costs were driven by tertiary care resources arising from treatment-related adverse events, disease complications and inpatient procedures. In the scenario analysis, medical resource unit costs were inflated by 18.7% and 39.4%, triggering an average increase in cost across all ORCs of 1998 TRY and 4210 TRY, respectively.
Conclusion
Our findings confirm that obesity and its complications result in significant financial burden to the public healthcare system. By quantifying the burden of obesity across a comprehensive spectrum of ORCs, our study aims to support the economic case for investing in appropriate obesity interventions.
Data Sharing Statement
All supporting data for the analysis are presented in this manuscript. The survey template is available from the corresponding author upon reasonable request.
Ethics Declarations
The study was conducted according to ESOMAR guidelines, and informed consent was required for participation in surveys. Before commencement of the survey, participants were asked to provide consent for anonymized data to be included in publications and were advised that any adverse events or product complaints raised would be reported to the relevant company. In addition, given that no subject-identifiable data were generated, and the surveillance activities implied no risk or burden for any individuals, the study authors judged that no additional ethical review board permission was required. The study was performed in accordance with the Declaration of Helsinki (1964).
Acknowledgments
The authors would like to thank all physicians who have provided data for the study. The study team would also like to thank Sharanya J Jois and Malvin Kang for their assistance with data cleaning for the analyses.
Disclosure
DGY declares receiving support from Novo Nordisk, Sanofi, Boehringer Ingelheim and Amgen to speak at scientific events, and honoraria from Novo Nordisk and Sanofi for attending advisory boards. BG, ESY and AB are employed by Novo Nordisk. OA reports consultant for Novo Nordisk, during the conduct of the study. KL and AG report Ipsos project fees from Novo Nordisk, during the conduct of the study. The authors report no other conflicts of interest in this work.