I costi della sindrome metabolica

The costs of the metabolic syndrome



The metabolic syndrome is a constellation of risk factors (obesity, atherogenic dyslipidemia, raised blood pressure, insulin resistance) about which clinicians’ and health economists’ attention is growing. The present work is aimed at estimating the major medical costs directly related to the metabolic syndrome in Italy.

Materials and methods

The analysis is performed on an incremental basis, that is by comparing the amount of resources (drugs and hospitalisations for specific treatment) required by affected patients with the amount provided to the general population for similar (i.e. same ATC codes for drugs and same ICD-9 codes for admissions) resources. From the database of a large Local Health Unit in Northern Italy a general sample of 4974 patients was drawn, to whom an oral blood glucose lowering drug, a serum lipid reducing agent and an antihypertensive drug had been at least once prescribed during the observation period (years 2001 to 2003). An equal sized control group was selected in the remaining population records, matched by sex and age to the study group. Moreover, for particular purposes of deeper analysis, a “restricted” sample was defined as a subset (n = 1401) of the general one, where patients had received the above mentioned drugs at least once in each year of the observation period. As to the primary outcomes (demographic characteristics and basic average costs), the two kinds of samples (general and restricted) showed no considerable differences.


The metabolic syndrome affects males (49.5%) and females in the same proportion, while the mean age among the former sex group (64.6 years) is lower than among the latter (68.2 years). Yearly mortality among patients with metabolic syndrome (1.7%) does not differ from mortality in the general population. All costs in the study group were significantly higher than the corresponding in the control group. By the general sample, the total average cost per year for a patient with the metabolic syndrome was estimated at € 1,522 (drugs: € 558; hospitalisation: € 964), versus the lower analogous estimates in the general population: € 361 (total), € 155 (drugs), € 206 (hospitalisation). So, on a yearly and per capita basis, the (incremental) cost of the metabolic syndrome amounts to € 1,161. Mortality and age were shown to be particular cost drivers.


To the National Health Service in Italy, the cost for the metabolic syndrome might be as high as € 670 million a year (0.9% of the total public health expenditure).

This is a preview of subscription content, access via your institution.


  1. 1.

    Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–97

    Article  Google Scholar 

  2. 2.

    Yuen K, Wareham N, Frystyck J, et al. Short-term low-dose growth hormone administration in subjects with impaired glucose tolerance and the metabolic syndrome: effects on beta-cell function and post-load glucose tolerance. Eur J Endocrinol 2004; 151(1): 39–45

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Nashar K, Nguyen JP, Jesri A, et al. Angiotensin receptor blockade improves arterial distensibility and reduces exercise-induced pressor responses in obese hypertensive patients with the metabolic syndrome. Am J Hypertens 2004; 17(6): 477–82

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Derosa G, Cicero AF, Gaddi A, et al. Metabolic effects of pioglitazone and rosiglitazone in patients with diabetes and metabolic syndrome treated with glimepiride: a twelve-month, multicenter, double-blind, randomized, controlled, parallel-group trial. Clin Ther 2004; 26(5): 744–54

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Wang TD, Chen WJ, Lin JW, et al. Effects of rosiglitazone on endothelial function, C-reactive protein, and components of the metabolic syndrome in nondiabetic patients with the metabolic syndrome. Am J Cardiol 2004; 93(3): 362–5

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Herrmann BL, Berg C, Vogel E, et al. Effects of a combination of recombinant human growth hormone with metformin on glucose metabolism and body composition in patients with metabolic syndrome. Horm Metab Res 2004; 36(1): 54–61

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Watts GF, Chan DC, Barrett PH, et al. Effect of a statin on hepatic apolipoprotein B-100 secretion and plasma campesterol levels in the metabolic syndrome. Int J Obes Relat Metab Disord 2003; 27(7): 862–5

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Hunninghake DB, Ballantyne CM, Maccubbin DL, et al. Comparative effects of simvastatin and atorvastatin in hypercholesterolemic patients with characteristics of metabolic syndrome. Clin Ther 2003; 25(6): 1670–86

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Despres JP, Lemieux I, Pascot A, et al. Gemfibrozil reduces plasma C-reactive protein levels in abdominally obese men with the atherogenic dyslipidemia of the metabolic syndrome. Arterioscler Thromb Vasc Biol 2003; 23(4): 702–3

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Akbar DH. Effect of metformin and sulfonylurea on C-reactive protein level in well-controlled type 2 diabetics with metabolic syndrome. Endocrine 2003; 20(3): 215–8

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Watts GF, Barrett PH, Ji J, et al. Differential regulation of lipoprotein kinetics by atorvastatin and fenofibrate in subjects with the metabolic syndrome. Diabetes 2003; 52(3): 803–11

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Esposito K, Marfella R, Ciotola M, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. A randomized trial. JAMA 2004; 292(12): 1440–6

    Article  CAS  Google Scholar 

  13. 13.

    Brady LM, Williams CM, Lovegrove JA. Dietary PUFA and the metabolic syndrome in Indian Asians living in the UK. Proc Nutr Soc 2004; 63(1): 115–25

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Laaksonen DE, Kainulainen S, Rissanen A, et al. Relationships between changes in abdominal fat distribution and insulin sensitivity during a very low calorie diet in abdominally obese men and women with the metabolic syndrome. Nutr Metab Cardiovasc Dis 2003; 13(6): 349–56

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Scott LW, Balasubramanyam A, Kimball KT, et al. Long-term, randomized clinical trial of two diets in the metabolic syndrome and type 2 diabetes. Diabetes Care 2003; 26(8): 2481–2

    PubMed  Article  Google Scholar 

  16. 16.

    Gree JS, Stanforth PR, Rankinen T, et al. The effects of exercise training on abdominal visceral fat, body composition, and indicators of the metabolic syndrome in postmenopausal women with and without estrogen replacement therapy: the HERITAGE family study. Metabolism 2004; 53(9): 1192–6

    Article  Google Scholar 

  17. 17.

    Troseid M, Lappegard KT, Claudi T, et al. Exercise reduces plasma levels of the chemokines MCP-1 and IL-8 in subjects with the metabolic syndrome. Eur Heart J 2004; 25(4): 349–55

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Dumortier M, Brandou F, Perez-Martin A, et al. Low intensity endurance exercise targeted for lipid oxidation improves body composition and insulin sensitivity in patients with the metabolic syndrome. Diabetes Metab 2003; 29(5): 509–18

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Rennie KL, McCarthy N, Yazdgerdi S, et al. Association of the metabolic syndrome with both vigorous and moderate physical activity. Int J Epidemiol 2003; 32(4): 600–6

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Hittel DS, Kraus WE, Hoffman EP. Skeletal muscle dictates the fibrinolytic state after exercise training in overweight men with characteristics of metabolic syndrome. J Physiol 2003; 548 (Pt 2): 401–10

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    ISTAT. Annuario Statistico Italiano 2004. Roma: Istituto Nazionale di Statistica, 2004: 832

    Google Scholar 

  22. 22.

    Evoluzione della spesa sanitaria dal 1995 al 2001. Monitor 2003; 2: 63–8

  23. 23.

    Pearce LC. Metabolic syndrome & Obesity: Co-epidemics could overwhelm Home Health Care. Caring Magazine 2003; June: 24–35

    Google Scholar 

  24. 24.

    OECD Health Data 2002

Download references

Author information



Corresponding author

Correspondence to Dott. C. Lucioni.

Additional information

I peer reviewers, per questo articolo, sono stati coordinati da Andrea Messori.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lucioni, C., Mazzi, S., Cerra, C. et al. I costi della sindrome metabolica. Pharmacoeconomics-Ital-Res-Articles 7, 89–99 (2005). https://doi.org/10.1007/BF03320540

Download citation