, Volume 27, Issue 12, pp 1031–1044

Healthcare Costs and Obesity Prevention

Drug Costs and Other Sector-Specific Consequences
  • David R. Rappange
  • Werner B. F. Brouwer
  • Rudolf T. Hoogenveen
  • Pieter H. M. Van Baal
Original Research Article


Background: Obesity is a major contributor to the overall burden of disease (also reducing life expectancy) and associated with high medical costs due to obesity-related diseases. However, obesity prevention, while reducing obesity-related morbidity and mortality, may not result in overall healthcare cost savings because of additional costs in life-years gained. Sector-specific financial consequences of preventing obesity are less well documented, for pharmaceutical spending as well as for other healthcare segments.

Objective: To estimate the effect of obesity prevention on annual and lifetime drug spending as well as other sector-specific expenditures, i.e. the hospital segment, long-term care segment and primary healthcare.

Methods: The RIVM (Dutch National Institute for Public Health and the Environment) Chronic Disease Model and Dutch cost of illness data were used to simulate, using a Markov-type model approach, the lifetime expenditures in the pharmaceutical segment and three other healthcare segments for a hypothetical cohort of obese (body mass index [BMI] ≥30 kg/m2), non-smoking people with a starting age of 20 years. In order to assess the sector-specific consequences of obesity prevention, these costs were compared with the costs of two other similar cohorts, i.e. a ‘healthy-living’ cohort (non-smoking and a BMI ≥18.5 and <25 kg/m2) and a smoking cohort. To assert whether preventing obesity results in cost savings in any of the segments, net present values were estimated using different discount rates. Sensitivity analyses were conducted across key input values and using a broader definition of healthcare.

Results: Lifetime drug expenditures are higher for obese people than for ‘healthy-living’ people, despite shorter life expectancy for the obese. Obesity prevention results in savings on drugs for obesity-related diseases until the age of 74 years, which outweigh additional drug costs for diseases unrelated to obesity in life-years gained. Furthermore, obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Discounting costs more heavily or using lower relative mortality risks for obesity would make obesity prevention a relatively more attractive strategy in terms of healthcare costs, especially for the long-term care segment. Application of a broader definition of healthcare costs has the opposite effect.

Conclusions: Obesity prevention will likely result in savings in the pharmaceutical segment, but substantial additional costs for long-term care. These are important considerations for policy makers concerned with the future sustainability of the healthcare system.


  1. 1.
    World Health Organization (WHO). Obesity: preventing and managing the global epidemic. Report of the WHO consultation of obesity. WHO Technical Report Series 894. Geneva: World Health Organization, 2000Google Scholar
  2. 2.
    Abelson PH, Kennedy D. The obesity epidemic [editorial]. Science 2004; 304: 1413PubMedCrossRefGoogle Scholar
  3. 3.
    World Health Organization (WHO). Obesity and overweight. Factsheet N 311 [online]. Available from URL: ( [Accessed 2008 Dec 12]
  4. 4.
    Kelly T, Yang W, Chen C-S, et al. Global burden of obesity in 2005 and projections to 2030. Int J Obes 2008; 32: 1431–7CrossRefGoogle Scholar
  5. 5.
    Visscher TLS, Seidell JC. The public health impact of obesity. Annu Rev Public Health 2001; 22: 355–75PubMedCrossRefGoogle Scholar
  6. 6.
    Haslam DW, James WPT. Obesity. Lancet 2005; 366: 1197–209PubMedCrossRefGoogle Scholar
  7. 7.
    Hu FB. Obesity epidemiology. New York: Oxford University Press, 2008CrossRefGoogle Scholar
  8. 8.
    Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 2009; 373: 1083–96PubMedCrossRefGoogle Scholar
  9. 9.
    Neovius M, Sundström J, Rasmussen F. Combined effects of overweight and smoking in late adolescence on subsequent mortality: nationwide cohort study. BMJ 2009; 338: b496CrossRefGoogle Scholar
  10. 10.
    Organization for Economic Cooperation and Development (OECD). Health at a glance. Paris: OECD, 2005Google Scholar
  11. 11.
    Allison DB, Zannolli R, Narayan V. The direct health care costs of obesity in the United States. Am J Public Health 1999; 89: 1194–9PubMedCrossRefGoogle Scholar
  12. 12.
    Thompson D, Edelsberg J, Colditz GA, et al. Lifetime health and economic consequences of obesity. Arch Intern Med 1999; 159: 2177–83PubMedCrossRefGoogle Scholar
  13. 13.
    van Baal PHM, Polder JJ, de Wit GA, et al. Lifetimemedical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med 2008; 5 (2): e29CrossRefGoogle Scholar
  14. 14.
    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003; 289: 187–93PubMedCrossRefGoogle Scholar
  15. 15.
    Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a lifetable analysis. Ann Intern Med 2003; 138: 24–32PubMedGoogle Scholar
  16. 16.
    Olshanksy SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138–45CrossRefGoogle Scholar
  17. 17.
    Barendregt JJ, Bonneux L, van der Maas PJ. The health care costs of smoking. N Engl J Med 1997; 337: 1052–7PubMedCrossRefGoogle Scholar
  18. 18.
    Sloan FAOJ, Picone G, Conover C, et al. The price of smoking. Cambridge (MA): MIT Press, 2004Google Scholar
  19. 19.
    Hoogenveen RT, Verkleij H, Jager JC. Investigation into the substitution of mortality and the impact of competing risks in case of quantitative health targets [in Dutch]. Bilthoven: National Institute for Public Health and the Environment (RIVM), 1990Google Scholar
  20. 20.
    Spilman BC, Lubitz J. The effect of longevity on spending for acute and long-term care. N Engl J Med 2000; 342: 1409–15CrossRefGoogle Scholar
  21. 21.
    Slobbe ICJ, Kommer GJ, Smit JM, et al. Cost of illness in the Netherlands [in Dutch]. Bilthoven: National Institute for Public Health and the Environment (RIVM), 2006Google Scholar
  22. 22.
    Ministry of Health, Welfare, and Sport (VWS). Health insurance in the Netherlands: the new health insurance system from 2006. The Hague: VWS, 2005Google Scholar
  23. 23.
    Van de Ven WPMM, Schut FT. Universal mandatory health insurance in The Netherlands: a model for the United States? Health Aff 2008; 27: 771–81CrossRefGoogle Scholar
  24. 24.
    Schut FT, van de Ven WPMM. Rationing and competition in the Dutch health-care system. Health Econ 2005; 14: S59–74CrossRefGoogle Scholar
  25. 25.
    Council for Public Health and Health Care (RVZ). The labour market and demand for care [in Dutch]. The Hague: RVZ, 2006Google Scholar
  26. 26.
    Collins RW, Anderson JW. Medication cost savings associated with weight loss for obese non-insulin-dependent diabetic men and women. Prev Med 1995; 24: 369–74PubMedCrossRefGoogle Scholar
  27. 27.
    Greenway FL, Ryan DH, Bray GA, et al. Pharmaceutical cost savings of treating obesity with weight loss medications. Obes Res 1999; 7: 523–31PubMedCrossRefGoogle Scholar
  28. 28.
    Narbro K, Ågren G, Jonsson E, et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment. The SOS intervention study. Arch Intern Med 2002; 162: 2061–9PubMedCrossRefGoogle Scholar
  29. 29.
    Ågren G, Narbro K, Näslund I, et al. Long-term effects of weight loss on pharmaceutical costs in obese subjects: a report from the SOS intervention study. Int J Obes 2002; 26: 184–92CrossRefGoogle Scholar
  30. 30.
    Hoogenveen RT, van Baal PHM, Boshuizen HC. Chronic disease projections in heterogeneous aging populations: approximating multi-state models of joint distributions by modelling marginal distributions. Math Med Biol. Epub 2009 Jun 10Google Scholar
  31. 31.
    Van Baal PHM, Hoogenveen RT, de Wit GA, et al. Estimating health-adjusted life expectancy conditional on risk factors: results for smoking and obesity. Popul Health Metr 2006; 4: 14PubMedCrossRefGoogle Scholar
  32. 32.
    Struijs JN, van Genugten ML, Evers SM, et al. Modeling the future burden of stroke in The Netherlands: impact of aging, smoking, and hypertension. Stroke 2005; 36: 1648–55PubMedCrossRefGoogle Scholar
  33. 33.
    Jacobs-van der Bruggen MA, Bos G, Bemelmans WJ, et al. Lifestyle interventions are cost-effective in people with different levels of diabetes risk: results from a modeling study. Diabetes Care 2007; 30: 128–34CrossRefGoogle Scholar
  34. 34.
    World Health Organization (WHO) expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004; 363: 157–63CrossRefGoogle Scholar
  35. 35.
    National Institute for Public Health and the Environment. Cost of illness in the Netherlands [online]. Available from URL: ( [Accessed 2009 Sep 8]
  36. 36.
    Meerding WJ, Bonneux L, Polder JJ, et al. Demographic and epidemiological determinants of health care costs in the Netherlands: cost of illness study. BMJ 1998; 317: 111–5PubMedCrossRefGoogle Scholar
  37. 37.
    World Health Organization (WHO). International classification of diseases, injuries and causes of death, 9th revision. Geneva: WHO, 1977Google Scholar
  38. 38.
    Organization for Economic Cooperation and Development (OECD). A system of health accounts. Version 1.0. Paris: OECD, 2000Google Scholar
  39. 39.
    Health Care Insurance Board (CVZ). Guidelines for pharmacoeconomic research, updated version. Diemen: CVZ, 2006Google Scholar
  40. 40.
    Gold MR, Siegel JE, Russel LB, et al., editors. Cost effectiveness in health and medicine. Oxford: Oxford University Press, 1996Google Scholar
  41. 41.
    Smith DH, Gravelle H. The practice of discounting in economic evaluations of healthcare interventions. Int J Technol Assess Health Care 2001; 17: 236–43PubMedCrossRefGoogle Scholar
  42. 42.
    Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press Inc., 2005Google Scholar
  43. 43.
    Reuser M, Bonneux LG, Willekens FJ. The burden of mortality of obesity at middle and old age is small: a life table analysis of the US Health and Retirement Study. Eur J Epidemiol 2008; 23: 601–7PubMedCrossRefGoogle Scholar
  44. 44.
    Flegal KM, Graubard BI, Williamson DF, et al. Excess deaths associated with underweight, overweight, and obesity. JAMA 2005; 293: 1861–7PubMedCrossRefGoogle Scholar
  45. 45.
    Allison DB, Fontaine KR, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA 1999; 282: 1530–8PubMedCrossRefGoogle Scholar
  46. 46.
    Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States, 2000. JAMA 2004; 291: 1238–45PubMedCrossRefGoogle Scholar
  47. 47.
    Mokdad AH, Marks JS, Stroup DF, et al. Correction: actual causes of death in the United States, 2000. JAMA 2005; 293: 293PubMedCrossRefGoogle Scholar
  48. 48.
    Comas-Herrera A, Wittenberg R, Pickard L, et al. Cognitive impairment in older people: future demand for long-term care services and the associated costs. Int J Geriatr Psychiatry 2007; 22: 1037–45PubMedCrossRefGoogle Scholar
  49. 49.
    Yang Z, Norton EC, Stearns SC. Longevity and health care expenditures: the real reasons older people spend more. J Gerontol B Psychol Sci Soc Sci 2003; 58 (1): S2–10CrossRefGoogle Scholar
  50. 50.
    Van Baal PHM, van den Berg M, Hoogenveen RT, et al. Cost effectiveness of a low-calorie diet and orlistat for obese persons: modelling long term health gains through prevention of obesity- related chronic diseases. Value Health 2008; 11: 1033–40PubMedCrossRefGoogle Scholar
  51. 51.
    Bemelmans WJE, van Baal PHM, Wendel-Vos WV, et al. The costs, effects and cost-effectiveness of counteracting overweight on a population level. Prev Med 2008; 46: 123–32CrossRefGoogle Scholar
  52. 52.
    Van Baal PHM, Brouwer WBF, Hoogenveen RT, et al. Increasing tobacco taxes: a cheap tool to increase public health. Health Policy 2007; 28: 142–52CrossRefGoogle Scholar
  53. 53.
    Van Baal PHM, Feenstra TL, Hoogenveen RT, et al. Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect cost-utility ratio’. Health Econ 2007; 16: 421–33PubMedCrossRefGoogle Scholar
  54. 54.
    Brouwer WBF, van Exel NJA, van Baal PHM, et al. Economics and public health: engaged to be happily married! Eur J Public Health 2007; 17: 122–3PubMedCrossRefGoogle Scholar
  55. 55.
    Cutler DM, Rosen AB, Vijan S. The value of medical spending in the United States, 1960-2000. N Engl J Med 2006; 355: 920–7PubMedCrossRefGoogle Scholar
  56. 56.
    Narbro K, Ågren G, Jonsson E, et al. Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study. Int J Obes Relat Metab Disord 1999; 23: 619–24PubMedCrossRefGoogle Scholar
  57. 57.
    Vissher TLS, Rissanen A, Seidell JC, et al. Obesity and unhealthy life-years in adult Finns: an empirical approach. Arch Intern Med 2004; 164: 1413–20CrossRefGoogle Scholar
  58. 58.
    Sullivan PW, Ghushchyan V, Wyatt HR, et al. Productivity costs associated with cardiometabolic risk factor clusters in the United States. Value Health 2007; 10: 443–50PubMedCrossRefGoogle Scholar
  59. 59.
    Neovius M, Kark M, Rasmussen F, et al. Association between obesity status in young adulthood and disability pension. Int J Obes 2008; 32: 1319–26CrossRefGoogle Scholar
  60. 60.
    Meltzer D. Accounting for future costs in medical costeffectiveness analysis. J Health Econ 1997; 16: 33–64PubMedCrossRefGoogle Scholar
  61. 61.
    Seidell JC. Epidemiology and health economics of obesity. Medicine 2006; 34: 506–9CrossRefGoogle Scholar
  62. 62.
    Polder JJ, Takkern J, Meerding WJ, et al. Cost of illness in the Netherlands [in Dutch]. Bilthoven: National Institute for Public Health and the Environment (RIVM), 2002Google Scholar
  63. 63.
    Rappange DR, Brouwer WBF, Rutten FFH, et al. Lifestyle intervention: from cost savings to value for money. J Public Health. Epub 2009 Aug 7Google Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • David R. Rappange
    • 1
  • Werner B. F. Brouwer
    • 1
  • Rudolf T. Hoogenveen
    • 2
  • Pieter H. M. Van Baal
    • 2
  1. 1.Department of Health Policy & Management and Institute for Medical Technology AssessmentErasmus University Medical CentreRotterdamthe Netherlands
  2. 2.National Institute for Public Health and the EnvironmentCentre for Prevention and Health Services ResearchBilthoventhe Netherlands

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