Distribution of direct healthcare - PowerPoint Presentation

1. Distribution of direct healthcare costs and obesity-related complications among high-cost individuals living with obesity: a UK retrospective open cohort study1Lane Clark & Peacock LLP, London, UK2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK3Novo Nordisk A/S, Søborg, Denmark4Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UKJonathan Pearson-Stuttard,1,2 Sara Holloway,1 Kasper Sommer Matthiessen,3 Andrew Thompson,1,4 Silvia Capucci3

2. Respiratory conditionsCKDMusculoskeletal conditionsT2DGastrointestinal conditionsCVDDepressionIntroductionIncreasing BMI is associated with the development of ORCs, which contribute to healthcare costs and resource utilization for people with obesity.1An analysis using US data has suggested that the majority of direct healthcare costs in groups with obesity are contributed by a minority of individuals, who frequently have ORCs.21. Divino V et al. J Manag Care Spec Pharm 2021;27(2):210–22. 2. Pearson-Stuttard J et al. Poster presentation at the Zoom Forward 22 – ECO/IFSO-EC Congress on Obesity, 4–7 May 2022, Maastricht, Netherlands. Presentation number 177.BMI, body mass index; CKD, chronic kidney disease; CVD, cardiovascular disease; ORC, obesity-related complication; T2D, type 2 diabetes.

3. AimsIn this real-world, retrospective open cohort study, we used data from the UK Discover database to examine the demographic and clinical characteristics of people living with obesity who contributed the most to direct healthcare costs.Individuals with obesity were stratified into quintiles to assess the contribution of each quintile to the total direct healthcare costs in 2019.

4. DiscoverLinked electronic health records research dataset covering 2.8 million individuals across 365 primary care practices in North West London, UK.1Representative of the UK population with regard to age and sex, but more diverse in terms of ethnicity1 and deprivation.Sources of linked dataPrimary care:a EMRs, prescriptions.Secondary care:a demographics, dates of activity, diagnoses and procedures.aPrimary care data are available from 2004, with linkage to secondary care data from 2015.1. Bottle A et al. BMC Med Inform Decis Mak 2020;20(1):71.EMR, electronic medical record.Accounting for >95% of the population of North West London

5. OutcomesHealthcare costs PPPY for 2019 were calculated using the following dataPrimary care costs, derived from the Personal Social Services Research Unit (2020).Secondary care costs (inpatient and outpatient care and emergency department visits), derived from the Secondary Uses Service.Prescription costs, calculated using UK net ingredient costs.All outcomes were age-standardized to the European Standard Population 2013,1 and costs were adjusted to 2019 costs using UK Consumer Price Index inflation data from the ONS.1. Eurostat 2013. Available from: https://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-RA-13-028 (Accessed 14 February 2023).ONS, Office for National Statistics; PPPY, per person per year.

6. Study design and populationaDate of first eligible BMI measurement during the study period (1 January 2015–31 December 2019). bAlthough data are available in Discover up to 2022, the study followed up patients until 2019 to avoid the potential effect of the COVID-19 pandemic on healthcare utilization and outcomes.BMI, body mass index.2019bComorbidity prevalence and risk factors reassessed to reflect current health statusHealthcare utilization and costs (primary care, hospital care and prescriptions)Over follow-up: serial cross-sections assembled to assess outcomes per yearPatients followed for up to 5 years, until month of death, transfer out date or end of study period, whichever was earliest.Real-world, retrospective open cohort studyComorbiditiesDemographicsRisk factorsIndex dateaAt indexInclusion criteriaBaseline characteristics definedAge ≥18 yearsBMI ≥30 kg/m2

7. Results – Baseline characteristics of people living with obesity in the Discover databaseIn total, there were 590,291 individuals with a BMI measurement of ≥30 kg/m2 at any time during 2004–2019.Mean (SD) age: 44.0 (15.9) years.Sex: 54.6% women.More than 40% had ≥2 ORCs.aaORCs included in the total were ASCVD, asthma, back pain, CKD stage 3–5, dyslipidaemia, gastro-oesophageal reflux disease, HF, hypertension, obstructive sleep apnoea, osteoarthritis of the knee, polycystic ovary syndrome, prediabetes, psoriasis, T2D and urinary incontinence.ASCVD, atherosclerotic cardiovascular disease; BMI, body mass index; CKD, chronic kidney disease; HF, heart failure; ORC, obesity-related complication; SD, standard deviation, T2D, type 2 diabetes.Hypertension27.8% Osteoarthritis12.4%Back pain22.4%Depression3.8%ASCVD8.6%

8. Baseline demographics for the 2019 cross-sectionA total of 270,493 individuals were included in the 2019 cross-section.Mean age was approximately 13 years higher in the highest-cost quintile (Q5) than in the lowest-cost quintile (Q1) and a greater proportion were women.Mean BMI in 2019 was highest in the quintiles with the highest costs.Q, quintile; SD, standard deviation.Baseline characteristicObesity(N=270,493)Q1Q2Q3Q4Q5Age in 2019, years, mean (SD)49.9 (16.3)41.3 (13.3)44.7 (14.3)50.2 (15.2)54.5 (15.4)58.9 (16.5)Women, n (%)153,751 (56.8)24,618 (45.5)30,388 (56.2)32,079 (59.3)32,955 (60.9)33,711 (62.3)BMI in 2019, kg/m2, mean (SD)34.6 (4.9)34.2 (4.9)34.2 (4.7)34.5 (4.8)34.8 (5.0)35.1 (5.3)

9. The highest-cost quintile (Q5) accounted for over 70% of the direct healthcare costsa in 2019Total direct costs PPPY were £1445 in the overall cohort with obesity. Q5 accounted for more than 72% of the total direct healthcare costs in 2019.There was an almost five-fold increase in costs from Q4 to Q5.aAll costs are age-standardized to the European Standard Population1 and adjusted to 2019 prices.1. Eurostat 2013. Available from: https://ec.europa.eu/eurostat/web/products-manuals-and-guidelines/-/KS-RA-13-028 (Accessed 14 February 2023).GBP, pound sterling; PPPY, per person per year; Q, quintile.

10. Individuals in the highest-cost quintile were considerably more likely to have ≥3 ORCsa or ≥2 ORCsaaORCs were ASCVD, asthma, back pain, CKD stage 3–5, dyslipidaemia, gastro-oesophageal reflux disease, HF, hypertension, obstructive sleep apnoea, osteoarthritis of the knee, polycystic ovary syndrome, prediabetes, psoriasis, T2D and urinary incontinence. Prevalence was age-standardized to the European Standard Population in 2013. bPrevalence for each comorbidity was calculated at mid-year (1 July) in the calendar year analysis. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; HF, heart failure; ORC, obesity-related complication; Q, quintile; T2D, type 2 diabetes.

11. Individuals in the highest-cost quintile were more likely to have ASCVD, T2D or depressionaPrevalence for each comorbidity was calculated at mid-year (1 July) in the calendar year analysis. ASCVD, atherosclerotic cardiovascular disease; ORC, obesity-related complication; Q, quintile; T2D, type 2 diabetes.

12. ConclusionsIn a UK real-world population with obesity, 20% of individuals accounted for over 70% of the direct healthcare costs in 2019. ASCVD, atherosclerotic cardiovascular disease; ORC, obesity-related complication; T2D, type 2 diabetes.Older age, female sex and a higher likelihood of multiple ORCs (especially ASCVD, T2D and depression) were characteristic of the highest-cost quintile in our analyses.These findings are important to guide the allocation of limited healthcare resources towards people living with obesity who have the greatest unmet need.