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

BACKGROUND: TRICARE's Prime (managed care) plan spends more than $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 $440 (3% discount rate) for each permanent 1% reduction in body weight. This includes $590 in savings from improved health, offset by $150 in additional expenditures from prolonged life. Estimates range from $660 reduction for grossly obese adults aged <45 years to $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 $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.

Cost of gestational diabetes mellitus in the United States in 2007.

The objective of this study was to estimate the national medical costs associated with gestational diabetes mellitus (GDM) in 2007. We analyzed the National Hospital Discharge Survey to estimate the national prevalence of GDM. Using Poisson regression analysis with medical claims for about 27,000 newborns and their mothers, we estimated rate ratios that reflect the increase in use of health care services associated with GDM. Combining GDM prevalence rates with these rate ratios, we calculated etiological fractions that reflect the proportion of national health care resource use associated with GDM. We then multiplied these fractions by estimates of national health care use and costs in 2007. GDM prevalence increases with age, rising from 1.3% of pregnancies of women younger than age 21 to 8.7% of pregnancies of women older than age 35. For the estimated 180,000 GDM pregnancies resulting in delivery, average expenditures increased $3,305 per pregnancy plus $209 in the newborn's first year of life. GDM increased national medical costs by $636 million in 2007-$596 million for maternal costs and $40 million for neonatal costs. Approximately $230 million (36%) of GDM-related medical costs are covered by government programs (primarily Medicaid), $355 million (56%) are covered by private insurers, and $51 million (8%) are covered by self-pay and charity care. GDM imposes a significant economic burden. These estimates of the economic burden of GDM are likely conservative because we focus on near-term medical costs, omitting the increased risk for long-term sequelae.