Top

Applied Health Economics and Health Policy

Published in:

Open Access 01-11-2012 | Original Research Article

Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain

The ECOBIM Study

Authors: Dr Tatiana Dilla, PharmD, Amparo Valladares, Claudia Nicolay, Javier Salvador, Jesús Reviriego, María Costi

Published in: Applied Health Economics and Health Policy | Issue 6/2012

Abstract

Background: Weight management is considered a key therapeutic strategy in type 2 diabetes mellitus. However, little is known about the impact of weight loss or body mass index (BMI) reduction on type 2 diabetes-related healthcare costs.

Objective: The aim of this study was to estimate the economic impact of change in BMI among patients with type 2 diabetes mellitus from the Spanish healthcare system perspective.

Methods: The ECOBIM study is an observational, non-interventional study in which data on BMI change and costs incurred by patients with type 2 diabetes were collected cross-sectionally and retrospectively for a 12-month period. Generalized linear mixed models were applied to estimate the effects of (i) BMI change in general (one-slope model); (ii) BMI gain and no BMI gain (two-slope model); and (iii) BMI gain and no BMI gain among obese and non-obese patients (four-slope model).

Results: We studied 738 patients with a mean (SD) age of 66 (11) years and BMI of 30.6 (5.2) kg/m². During the 12-month study period, 41.2% of patients gained BMI (BMI gainers) and 58.8% experienced either loss (52.2%) or no change (6.6%) in BMI (non-BMI gainers). One-unit gain (or loss) in BMI was significantly (p<0.001) associated with a 2.4% cost increase (or decrease) [one-slope model]. Every unit gain in BMI was associated with a 20.0% increase in costs among BMI gainers while losing one unit was associated with an 8.0% decrease in costs among non-BMI gainers (two-slope model, p<0.01). The economic benefit associated with reducing one BMI unit was 9.4% cost decrease in obese and 2.7% in non-obese patients (4-slope model).

Conclusion: An increase in BMI among patients with type 2 diabetes was associated with increased 1-year direct healthcare costs. A reduction in BMI was associated with appreciable short-term economic benefits, especially in obese patients.

European Region and Federation of European Nurses in Diabetes. Diabetes — the policy puzzle: is Europe making progress? (2nd ed). International Diabetes Federation, 2010. Available from URL: http://ec.europa.eu/health/major_chronic_diseases/docs/policy_puzzle_2008.pdf [Accessed 2012 Aug 30]

Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010 Jan; 87(1): 4–14PubMedCrossRef

International Diabetes Federation. Prevalence estimates of diabetes mellitus (DM), 2010. International Diabetes Federation, Brussels 2010. Available from URL: http://www.diabetesatlas.org [Accessed 2010 May 24]

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2005 Jan; 28 Suppl. 1: S37–42CrossRef

Fu AZ, Qiu Y, Radican L, et al. Health care and productivity costs associated with diabetic patients with macrovascular comorbid conditions. Diabetes Care 2009 Dec; 32(12): 2187–92PubMedCrossRef

Jendle JH. Resource utilisation and costs for the treatment of diabetes in the developed world: an economical burden that needs to be solved. Int J Clin Pract 2009 Jul; 63(7): 980–2PubMedCrossRef

Oliva J, Lobo F, Molina B, et al. Direct health care costs of diabetic patients in Spain. Diabetes Care 2004 Nov; 27(11): 2616–21PubMedCrossRef

Mata M, Antoñanzas F, Tafalla M, et al. The cost of type 2 diabetes in Spain: the CODE-2 study [in Spanish]. Gac Sanit 2002 Nov-Dec; 16(6): 511–20PubMedCrossRef

Ballesta M, Carral F, Olveira G, et al. Economic cost associated with type II diabetes in Spanish patients. Eur J Health Econ 2006 Dec; 7(4): 270–5PubMedCrossRef

10.

González P, Faure E, Del Castillo A, et al. Cost of diabetes mellitus in Spain [in Spanish]. Med Clin (Barc) 2006 Nov; 127(20): 776–84CrossRef

11.

Jurado J, Ybarra J, Solanas P, et al. Prevalence of cardiovascular disease and risk factors in a type 2 diabetic population of the North Catalonia diabetes study. J Am Acad Nurse Pract 2009 Mar; 21(3): 140–8PubMedCrossRef

12.

Serrano Rios M. Relationship between obesity and the increased risk of major complications in non-insulin-dependent diabetes mellitus. Eur J Clin Invest 1998 Sep; 28 Suppl. 2: 14–7, discussion 17–8PubMedCrossRef

13.

World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO Consultation [WHO Technical Report Series 894]. Geneva: WHO, 2000

14.

Dilla T, Costi M, Boye KS, et al. The impact of obesity in the management and evolution of diabetes mellitus [in Spanish]. Rev Clin Esp 2008 Oct; 208(9): 437–43PubMedCrossRef

15.

Laguna S, Príncipe RM, Botella S, et al. El índice de masa corporal y la circunferencia abdominal infraestiman el diagnóstico de obesidad en pacientes con diabetes mellitus tipo 2. Av. Diabetol 2010; 26: 173–7

16.

Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA 1999 Oct; 282(16): 1523–9PubMedCrossRef

17.

Hernández-Mijares A, Solá-Izquierdo E, Ballester-Mechó F, et al. Obesity and overweight prevalences in rural and urban populations in East Spain and its association with undiagnosed hypertension and Diabetes Mellitus: a cross-sectional population-based survey. BMC Res Notes 2009 Jul; 2: 151PubMedCrossRef

18.

Rana JS, Nieuwdorp M, Jukema JW, et al. Cardiovascular metabolic syndrome: an interplay of, obesity, inflammation, diabetes and coronary heart disease. Diabetes Obes Metab 2007 May; 9(3): 218–32PubMedCrossRef

19.

Alegría Ezquerra E, Castellano Vázquez JM, Alegría Barrero A. Obesity, metabolic syndrome and diabetes: cardiovascular implications and therapy [in Spanish]. Rev Esp Cardiol 2008 Jul; 61(7): 752–64PubMedCrossRef

20.

Klein S, Ghosh A, Cremieux PY, et al. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI ≥35 kg/m². Obesity (Silver Spring) 2011 Mar; 19(3): 581–7CrossRef

21.

Lloyd A, Sawyer W, Hopkinson P. Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value Health 2001 Sep–Oct; 4(5): 392–400PubMedCrossRef

22.

Koopmanschap M, CODE-2 Advisory Board. Coping with type II diabetes: the patient’s perspective. Diabetologia 2002 Jul; 45(7): S18–22PubMed

23.

Sach TH, Barton GR, Doherty M, et al. The relationship between body mass index and health-related quality of life: comparing the EQ-5D, EuroQol VAS and SF-6D. Int J Obes (Lond) 2007 Jan; 31(1): 189–96CrossRef

24.

Banegas JR, López-García E, Graciani A, et al. Relationship between obesity, hypertension and diabetes, and health-related quality of life among the elderly. Eur J Cardiovasc Prev Rehabil 2007 Jun; 14(3): 456–62PubMedCrossRef

25.

de Leiva A. What are the benefits of moderate weight loss? Exp Clin Endocrinol Diabetes 1998; 106 Suppl. 2: 10–3PubMedCrossRef

26.

Williams KV, Kelley DE. Metabolic consequences of weight loss on glucose metabolism and insulin action in type 2 diabetes. Diabetes Obes Metab 2000 Jun; 2(3): 121–9PubMedCrossRef

27.

Vidal J. Updated review on the benefits of weight loss. Int J Obes Relat Metab Disord 2002 Dec; 26 Suppl. 4: S25–8PubMedCrossRef

28.

Oblikue Consulting Health. Base de Datos de Costes Sanitarios eSALUD. Barcelona, 2008. Available from URL: http://www.oblikue.com/bddcostes/ [Accessed 2009 Feb 18]

29.

General Spanish Council of Pharmacists. BOT database of pharmaceutical prices, 2008 [online]. Available from URL: https://botplusweb.portalfarma.com/ [Accessed 2012 Aug 30]

30.

The EuroQol Group. EuroQol — a new facility for the measurement of health-related quality of life. Health Policy 1990 Dec; 16(3): 199–208CrossRef

31.

Reviriego J, Millan MD, Millan M. Evaluation of the diabetes quality-of-life questionnaire in a Spanish population: an experience of translation and reliability. Pharmacoeconomics 1996 Dec; 10(6): 614–22PubMedCrossRef

32.

Basu A, Manning WG, Mullahy J. Comparing alternative models: log vs. Cox proportional hazard? Health Econ 2004 Aug; 13(8): 749–65PubMedCrossRef

33.

Yu AP, Wu EQ, Birnbaum HG, et al. Short-term economic impact of body weight change among patients with type 2 diabetes treated with antidiabetic agents: analysis using claims, laboratory, and medical record data. Curr Med Res Opin 2007 Sep; 23(9): 2157–69PubMedCrossRef

34.

Heithoff KA, Cuffel BJ, Kennedy S, et al. The association between body mass and health care expenditures. Clin Ther 1997 Jul–Aug; 19(4): 811–20PubMedCrossRef

35.

Brandle M, Zhou H, Smith BR, et al. The direct medical cost of type 2 diabetes. Diabetes Care 2003 Aug; 26(8): 2300–4PubMedCrossRef

36.

Collins RW, Anderson JW. Medication cost savings associated with weight loss for obese non-insulin-dependent diabetic men and women. Prev Med 1995 Jul; 24(4): 369–74PubMedCrossRef

37.

Oster G, Thompson D, Edelsberg J, et al. Lifetime health and economic benefits of weight loss among obese persons. Am J Public Health 1999 Oct; 89(10): 1536–42PubMedCrossRef

38.

National Institute of Statistics. Census 2001 population figures by autonomous community and sex: data from year 2007[online]. Available from URL: http://www.ine.es/en/welcome_en.htm [Accessed 2012 Mar 23]

Title: Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain
The ECOBIM Study
Authors: Dr Tatiana Dilla, PharmD
Amparo Valladares
Claudia Nicolay
Javier Salvador
Jesús Reviriego
María Costi
Publication date: 01-11-2012
Publisher: Springer International Publishing
Published in: Applied Health Economics and Health Policy / Issue 6/2012
Print ISSN: 1175-5652
Electronic ISSN: 1179-1896
DOI: https://doi.org/10.1007/BF03261876

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Healthcare Costs Associated with Change in Body Mass Index in Patients with Type 2 Diabetes Mellitus in Spain

The ECOBIM Study

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2012

Do Higher-Priced Generic Medicines Enjoy a Competitive Advantage Under Reference Pricing?

Economic Implications of Rasburicase Treatment in Adult Patients with Tumour Lysis Syndrome

What Explains Willingness to Pay for Smoking-Cessation Treatments —Addiction Level, Quit-Rate Effectiveness or the Opening Bid?

Cost Effectiveness of Guanfacine Extended-Release versus Atomoxetine for the Treatment of Attention-Deficit/Hyperactivity Disorder

Acknowledgement

Inclusion of Compliance and Persistence in Economic Models