The costs and consequences of obesity in Germany: a new approach from a prevalence and life-cycle perspective

Abstract

With the steadily growing health burden of obesity in Germany, the measuring and quantification of its costs and relevant economic consequences have become increasingly important. The usual quantifications via previous cost-of-illness approaches mostly have several weaknesses, e.g., applying "indirect methods" by using "population-attributable fractions" to identify parts of costs that can be accrued to obesity, second using highly aggregated data and third often only displaying part of the costs. This article presents a new approach and a new estimation of the cost and consequences of obesity in Germany using claims data from a German health insurance company. A sample of 146,000 individuals was analyzed with both a prevalence and a life-cycle focus on the cost and consequences of obesity. With additional data sets, we calculate the deaths per year due to obesity, the excess costs per year and several intangible consequences usually referred to as "pain and suffering". Our results show that the cost estimations of obesity in Germany so far have been largely underestimated. The annual direct costs of obesity in Germany amount to approximately €29.39 billion and the indirect costs to an additional €33.65 billion. A total of 102,000 subjects die prematurely each year because of obesity, and there is a significant excess of unemployment, long-term nursing care, and pain and suffering due to obesity. From a lifetime perspective, every obese man is equal to an additional burden of €166,911 and each woman of €206,526 for the social security system in Germany. Obesity due to unhealthy eating is thus about to replace tobacco consumption in terms of costs and consequences as the main hazardous lifestyle factor and thus should be more intensively focussed by public health policy.

Economic Burden of Obesity: A Systematic Literature Review

“…We included twenty-three studies in this review [29,30,31,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54]. Detailed characteristics of these studies are presented in Table 1.…”

“…Detailed characteristics of these studies are presented in Table 1. Eleven studies [29,30,38,39,40,44,45,46,50,53,54] used a top-down (population-based) approach and eleven studies applied a bottom-up (person-based) approach [31,35,36,37,41,42,43,47,48,51,52] to calculate the costs attributable to obesity. The top-down approach estimates economic costs by using aggregate data on mortality, morbidity, hospital admissions, general practice consultations, disease-related costs, and other health-related indicators along with population attributable fraction (PAF) or population attributable risk (PAR) to calculate attributable costs [55,56,57].…”

“…The items that were included in the estimation of the patient-level data included drug medication in all twelve studies, but the other items, e.g., hospitalization costs, physician visit costs, inpatient and outpatient costs, varied across all studies. For example, whereas An [36] included out-of-pocket expenses, inpatient and outpatient costs, office-based medical provider services, emergency room services and medication, Effertz et al [42] considered nursing costs, rehabilitation treatments, and financial compensations for job integrations, accidents, and medication.…”

“…There were 17 studies from developed countries [31,35,36,37,39,41,42,43,44,45,46,47,48,49,51,52,54] and six studies from developing countries [29,30,38,40,50,53] according to the World Economic Situation and Prospects (WESP) report. According to the WESP and Organization for Economic Co-operation and Development (OECD), there is no established convention for the designation of “developed” and “developing” countries, but in common practice, Japan, Canada, the USA and European countries, for example, are considered “developed” countries, while Mexico and Brazil are considered to be “developing” countries [59].…”

“…According to the WESP and Organization for Economic Co-operation and Development (OECD), there is no established convention for the designation of “developed” and “developing” countries, but in common practice, Japan, Canada, the USA and European countries, for example, are considered “developed” countries, while Mexico and Brazil are considered to be “developing” countries [59]. There were six studies from Germany [42,43,44,46,47,54], six from the USA [31,36,37,39,51,52], three from Brazil [30,38,40] and two from Canada [35,45]. …”