Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure
Pieter H. M. van Baal1*, Johan J. Polder2,3, G. Ardine de Wit1, Rudolf T. Hoogenveen1, Talitha L. Feenstra1, Hendriek C. Boshuizen1, Peter M. Engelfriet1, Werner B. F. Brouwer4
1 National Institute for Public Health and the Environment (RIVM), Centre for Prevention and Health Services Research, Bilthoven, The Netherlands, 2 National Institute for Public Health and the Environment, Centre for Public Health Forecasting, Bilthoven, The Netherlands, 3 Tilburg University, Department Tranzo, Tilburg, The Netherlands, 4 Erasmus University, Medical Center, Rotterdam, The Netherlands
Background
Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention.
Methods and Findings
With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions.
Conclusions
Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.
Funding: This work was funded by the Dutch Ministry of Health, Welfare and Sports. The funder did not have any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interest exist.
Academic Editor: Andrew Prentice, London School of Hygiene & Tropical Medicine, United Kingdom
Citation: van Baal PHM, Polder JJ, de Wit GA, Hoogenveen RT, Feenstra TL, et al. (2008) Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure. PLoS Med 5(2): e29 doi:10.1371/journal.pmed.0050029
Received: June 20, 2007; Accepted: November 30, 2007; Published: February 5, 2008
Copyright: © 2008 van Baal et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abbreviations: BMI, body mass index; COI, cost of illness; RIVM-CDM, National Institute for Public Health and the Environment chronic disease model; SHA, System of Health Accounts
* To whom correspondence should be addressed. E-mail: pieter.van.baal@rivm.nl
