Objectives: This study determines the distribution of health care costs by place of service (POS; pharmacy, doctor's office, inpatient hospital, outpatient hospital or clinic, emergency department, laboratory, and other) among employees based upon body mass index (BMI). Methods: Using 2003-2012 retrospective data from large employers throughout the US, employees' BMIs from health risk appraisal data defined three main cohorts (BMI< 27 [normal weight], 27< = BMI< 30 [overweight] and BMI> = 30 [obese]). The 27< = BMI< 30 cohort was further divided into 3 comorbidity subcohorts: those without diabetes, hypertension or dyslipidemia (NonT2DHtnDys), those with hypertension or dyslipidemia without diabetes (HtnDys), and those with diabetes with or without hypertension or dyslipidemia (T2D). All eligible employees were aged> = 18, had > = 12 months post-index health plan coverage, and had no pregnancy claims. Annual post-index costs were compared between cohorts and between subcohorts using two-part regression modeling, controlling for age, gender, marital status, race, salary, region, and index year. Results: This study included 39,696 (BMI< 27), 14,281 (27< = BMI< 30), and 18,801 (BMI> = 30) eligible employees, with total adjusted health care costs of $3,191, $3,695, and $4,844, respectively. Employees with higher BMI were significantly more likely to incur health care costs in every POS category. Obese employees (BMI> = 30) had particularly high inpatient costs compared to other cohorts, averaging twice the cost of the BMI< 27 cohort ($919 vs. $431, P< 0.05). Total costs among subcohorts of 27< = BMI< 30 were $2,863 (NonT2DHtnDys), $5,271 (HtnDys), and $7,594 (T2D). NonT2DHynDys employees had significantly lower health care cost than other subcohorts in every POS category. The T2D subcohort had significantly higher pharmacy, inpatient, doctor's office, laboratory and other health care costs when compared to HtnDys. Conclusions: Employees with higher BMI incurred higher average health care costs than other employees at all places of service. Comorbidities, particularly diabetes, exacerbate health care costs of overweight employees. This represents a significant economic burden for US employers given the high prevalence of overweight and obesity.
Abouzaid, S., Kleinman, N. L., Andersen, L., Wang, Z., & Powers, A. (2013). Cohort Analysis Assessing Health Care Costs Associated with Obesity at Various Places of Service in Employed Adults. Value in Health, 16(7), A380. https://doi.org/10.1016/j.jval.2013.08.334