The direct and indirect costs of obesity and overweight in Germany

Presenter: Alexander Konnopka, University of Leipzig

Abstract

Background: Obesity and overweight are risk factors for a large number of disorders including neoplasms, cardiovascular diseases, endocrinologic diseases and digestive diseases resulting in considerable health damage and societal costs. This study aimed to estimate the health burden and the direct as well as indirect costs of morbidity and mortality resulting from obesity and overweight in Germany in the year 2002.
Methods: We estimated deaths, years of potential life lost (YPLL), quality adjusted life years lost (QALYs) and health care utilization for various diseases associated with obesity and overweight, using the concept of attributable fractions and routine statistics. Direct costs were estimated for inpatient and outpatient treatment, rehabilitation, nursing care and non-medical costs. Indirect costs were estimated for sickness absence, early retirements and mortality considering paid as well as unpaid work, using the human capital approach and discounting future costs by 5% each year. To account for uncertainty various parameters were varied in sensitivity analyses.
Results: We estimated 37,100 deaths attributable to obesity and overweight with 443,872 consecutive YPLL and 381,788 lost QALYs. Obesity and overweight resulted in 5,149 million Euro of direct costs corresponding to 2.4% of overall German health care expenditures and 5,361 million Euro of indirect costs. Of direct costs 42% resulted from endocrinologic disorders like diabetes and obesity itself, followed by cardiovascular disorders (37%), neoplasms (15%) and digestive disorders (6%). Of indirect costs 40% resulted from paid and 60% from unpaid work, and 66% of overall indirect costs were due to mortality. Sensitivity analyses resulted in variations of direct costs between -50% and +69%, whereas indirect costs varied between -59% and +97%.
Conclusions: Obesity and overweight result in considerable mortality and direct as well as indirect costs, which may further increase due to increasing prevalence rates of obesity and overweight in Germany, especially among children and youths. The results of study call for an improvement and further development of effective strategies for preventing and dealing with obesity and overweight.