Utility Decrements Associated with Adult Overweight and Obesity in Australia: A Systematic Review and Meta-Analysis



The aim was to conduct a systematic review and meta-analysis of health state utility decrements associated with overweight and obesity in adults 18 years and over, for use in modelled economic evaluations in Australia.


A systematic review was conducted in nine databases to identify studies that reported health state utility values by weight status. Random-effects meta-analysis was used to synthesise average utility decrements (from healthy weight) associated with overweight, all obesity and obesity classes 1, 2 and 3. Heterogeneity surrounding utility decrements was assessed via sub-group analysis, random-effects meta-regression and sensitivity analyses.


Twelve studies were found for which data were used to synthesise utility decrements, estimated as overweight = 0.020 (95% confidence interval 0.010–0.030), all obesity = 0.055 (0.034–0.076), obesity class 1 = 0.047 (0.017–0.077), class 2 = 0.072 (0.028–0.116) and class 3 = 0.084 (0.039–0.130). There was considerable heterogeneity in our results, which could be accounted for by the different ages and utility instruments used in the contributing studies.


Our results demonstrate that elevated weight status is associated with small but statistically significant reductions in utility compared with healthy weight, which will result in reduced quality-adjusted life years when extrapolated across time and used in economic evaluations.

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We would like to thank Bernie Carr, Academic Liaison Librarian, Fisher Library, University of Sydney, for her assistance with the literature search strategy.

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Correspondence to Joseph Carrello.

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Joseph Carrello is supported by a Postgraduate Research Scholarship from the Australian Prevention Partnership Centre (TAPPC). Anagha Killedar is supported by a NHMRC PhD scholarship (#1169039). Amy Von Huben is supported by a Postgraduate scholarship in Health Economics-Patient Centred Care and Outcomes in Chronic Disease. Thomas Lung is supported by a NHMRC Early Career Fellowship (APP1141392) and the National Heart Foundation Postdoctoral Fellowship (award 101956).

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All authors declare they have no conflict of interest.

Availability of data and material

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Authors contributions

JC, AH, LB, SP and TL were involved in the concept and design of the paper. JC, AH, AK, AvH and TL were involved in the analysis and interpretation of the data. JC, AvH and TL were involved in the statistical analysis. JC, AH and AK were involved in drafting the manuscript. All authors were involved in the critical revision of the paper.

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Carrello, J., Hayes, A., Killedar, A. et al. Utility Decrements Associated with Adult Overweight and Obesity in Australia: A Systematic Review and Meta-Analysis. PharmacoEconomics (2021). https://doi.org/10.1007/s40273-021-01004-x

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