Weight loss and lifetime medical expenditures: a case study with TRICARE prime beneficiaries.

摘要

BACKGROUND: TRICARE's Prime (managed care) plan spends more than Dollars 1 billion annually in medical expenditures attributed to overweight and obesity. PURPOSE: This study estimates change in lifetime disease prevalence and medical expenditures associated with weight loss for beneficiaries in TRICARE's Prime plan. METHODS: This 2010 analysis uses Markov Chain Monte Carlo simulation with demographics, biometrics, health behavior, and disease presence for 857,200 overweight and 521,800 obese beneficiaries aged 18-64 years in 2008 to model future onset of diseases linked to excess weight. Prediction equations in the simulation come from multiple sources: (1) regression analysis with longitudinal (2007-2008) TRICARE medical claims and electronic health records for 2.1 million beneficiaries; (2) regression analysis with Medical Expenditure Panel Survey (2002-2007) and National Health and Nutrition Examination Survey (1999-2008) data; (3) cancer and mortality risk from Surveillance, Epidemiology, and End Results data; and (4) published findings from clinical trials. RESULTS: Among overweight and obese beneficiaries, lifetime medical expenditures declined Dollars 440 (3% discount rate) for each permanent 1% reduction in body weight. This includes Dollars 590 in savings from improved health, offset by Dollars 150 in additional expenditures from prolonged life. Estimates range from Dollars 660 reduction for grossly obese adults aged <45 years to Dollars 40 gain from grossly obese adults aged 55-64 years (where expenditures from increased longevity exceed savings from improved health). If weight loss is temporary and regained after 24 months, lifetime expenditures decline by Dollars 40 per 1% reduction in body weight. CONCLUSIONS: Long-term benefits from weight loss are substantially greater than short-term benefits, underscoring the need for a societal perspective to combat obesity.