Direct Healthcare Cost of Obesity in Brazil: An Application of the Cost-of-Illness Method from the Perspective of the Public Health System in 2011

Abstract

BackgroundObesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems.ObjectiveTo estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011.SettingsPublic hospitals and outpatient care.MethodsA cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web.ResultsDirect costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men.ConclusionThe cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

Determinants of outpatient expenditure within primary care in the Brazilian National Health System

“…22 Brazilian expenditure on bariatric surgery also increased from US$ 9.4 million in 2008 to US$ 17.4 million in 2011. 23 A similar pattern has been observed in developed nations. 24,25 Our findings also point out that primary care services have strategic relevance regarding preventive actions aimed towards controlling obesity and its future complications.…”

Influência do excesso de peso e da obesidade nos gastos em saúde nos domicílios brasileiros

“…Além disso, famílias com indivíduos com doenças crô-nicas foram 2,6 vezes mais propensas a gastar mais que US$ 1.000 anuais com assistência mé-dica 34 . Esses achados são relevantes na medida em que a obesidade está associada à ocorrência de diversas doenças crônicas 5,6,7 .…”

“…Dados do último inquérito que avaliou o estado nutricional da população brasileira indicam que a prevalência de obesidade entre crianças, adolescentes e indivíduos maiores de 20 anos é de, respectivamente, 14,3%, 4,9% e 14,8% 3 . Como consequência, a obesidade resulta em elevado custo para diversos países, principalmente aqueles desenvolvidos 4 , e no Brasil já se conhece a magnitude do impacto do sobrepeso e da obesidade para o sistema público de saúde, o Sistema Único de Saúde (SUS) 5,6,7 .…”

“…A obesidade também está relacionada a alguns desses fatores 20,21,22 e, uma vez que esta tem impacto financeiro sobre o SUS 5,6,7 , pode também resultar em maiores gastos em saúde para as famílias.…”

Policy Makers’ Views of Obesity-Related Challenges Around the World

“…Surveys in various state capitals show average annual increases of 1.05 % in overweight prevalence and 0.76 % in obesity prevalence in the adult population [12]. In consequence, the burden of obesity to the Brazilian national health system is also very high [13,14]: in 2011, 487.98 million Brazilian reals (roughly US$219.59 million) were spent on medium-and high-complexity health treatments for obesity and obesity-related diseases [15].…”