The Economic Cost of
Overweight and Obesity in
Ireland
Dr. Anne Dee
17/01/2014
Acknowledgements
• UCC Professor Ivan Perry, Dr. Anne Dee, Karen Kearns
• NUIG Professor Ciaran O’Neill, Dr. Edel Doherty, Dr.
Aoife Callan
• DCU Professor Anthony Staines, Dr. Treasa McVeigh,
Dr. Mary Rose Sweeney
• QUB - Professor Frank Kee
• National Cancer Registry - Dr. Linda Sharp
• Institute of Public Health - Professor Kevin Balanda
• Safefood- Dr Cliodhna Foley Nolan
Used with permission
Used with permission
Prevalence of Overweight and Obesity
Percentage increased risk for overweight
and obese females-cancers
250%
222%
200%
164%
150%
100%
85%
82%
66%
45%
50%
60%
53%
35%
8%
15%
13%
24%
20%
0%
Breast Post
menopausal
Large Bowel
Uterus
Oesophagus
Female Overweight
Female obese
Kidney
Pancreas
Gall bladder
Source Guh et al 2009,
WCRF 2007
Percentage increased risk for overweight and
obese males-cancers
140%
129%
120%
95%
100%
82%
80%
60%
51%
40%
40%
20%
13%
28%
21%
25%
5%
0%
Large Bowel Oesophagus
Male Overweight
Kidney
Pancreas
Male Obese
Gall bladder
Source Guh et al 2009,
WCRF 2007
Percentage risk increase for chronic diseases- Males
320.00%
250.00%
181% 176%
87%
t
Go
u
As
th
m
a
ise
Ga
llb
la
dd
e
rD
Obese male
43%
43%
20%
9%
as
e
DV
T
ns
ion
er
te
Hy
p
St
ro
ke
84% 70%
72%
51%
29%
28%
23%
Co
ba
ic
ro
n
Ch
Overweight male
144%
ain
Os
te
ro
oa
na
rt h
ry
rit
Ar
is
te
ry
Di
se
as
e
59%
ck
p
% increased risk
350%
300%
250%
200%
150%
100%
50%
0%
Disease
Source Guh et al 2009,
Bhole et al 2010
Percentage increased risk of chronic diseases-Females
300%
252.00%
% increased risk
250%
210.00%
181%
200%
144%
142%
150%
100%
59%
96%
80%
Overweight female
132%
Obese female
80%
50%
49%
15%
78%
70%
65%
44%
67%
25%
rD
t
Go
u
la
dd
e
As
th
m
a
ise
as
e
DV
T
ns
ion
er
te
St
ro
ke
Hy
p
Ga
llb
Ch
ro
n
ic
ba
ck
p
ain
Os
te
Co
oa
ro
rt h
na
r it
ry
is
Ar
te
ry
Di
se
as
e
0%
Disease
Source Guh et al 2009,
Bhole et al 2010
Type II diabetes in overweight & obesity in
males & females
1141%
1200%
1000%
800%
574%
600%
400%
200%
292%
140%
0%
Male
overweight
Male obese
Female
overweight
Female obese
Source Guh et al 2009
Literature review
Overweight and obesity account for
somewhere between 1% and 9% of total
healthcare costs
Non-healthcare costs may be as much
again or even more. Studies show them to
comprise 51% to 84% of total costs
Costs increase with increasing BMI
Methods- Included costs
• Healthcare costs include:
▫
▫
▫
▫
In-Patient
Out-patient
General Practice
Drugs and prescribing costs
• Non-healthcare costs include lost productivity due
to:
▫ Time off work due to overweight and obesity related
illness
▫ Premature mortality
Methods for the study
• Mixed :Top down supplemented by
Bottom up
Methods: Top-down
• Prevalence based approach
• Large cost datasets
• Calculate Population Attributable Fractions
(PAF) using Relative Risks and Prevalence rates
for overweight and obesity
• Apply PAF to cost data
• PAFs calculated by age and gender
Methods: Bottom-up
• Cross Sectional individual level
• data
• Probability of using service
• Additional probability of using service if
increased BMI
• Controlled for confounders
Methods: Healthcare costs – data sources
• SLÁN, TILDA and NIHS 2010/11 to map
healthcare usage by BMI
• HIPE and HIS data
• Drugs and prescribing using PCRS and
BSO data
Non-Healthcare costs – data sources
• Illness Benefit Data-both jurisdictions
▫ Limited data available relating medical conditions to
illness benefit payments
▫ Also some information available from SLAN
• CSO data on premature mortality
Direct costs
Republic of Ireland
Republic of Ireland
GP (Cross-sectional analyses)
Cost € €
Range Range
€ € Cost
15,700,000 –
30,000,000
22,900,000
7,100,000 –
91,100,000
45,910,000
In-patient/day case (PAF method)
125,686,873216,025,571
172,849,916
Out-patient (Cross-sectional analyses)
(significant at 90% level)
0- 14,855,791
6,890,000
Drugs (PAF method)
156,294,603312,589,205
234,441,904
Indirect costs Absenteeism (Cross-sectional analyses)
Human capital approach
11,291,035547,385,875
282,667,747
Absenteeism (Cross-sectional analyses)
Friction cost approach
5,497,328164,215,771
71,715,511
Absenteeism (PAF method)
Human capital approach
104,106,280164,115,974
135,977,068
Absenteeism (PAF method)
Friction cost approach
54,904,90787,400,050
72,133,090
420,200,000748,500,000
592,991,594
In-patient/day case (Cross-sectional analyses)
Premature mortality (PAF method)
Northern Ireland
Direct costs
GP (Cross-sectional analyses)
Range PPP € Cost PPP 2009 €
2009
0-15,210,484
7,411,564
In-patient/Day-case (Cross-sectional analyses)
31,187,634133,410,785
82,299,148
In-patient/Day-case (PAF method)
28,613,87057,227,740
42,920,805
No significant difference
detected
Out-patient (Cross-sectional analyses)
Drugs (PAF method)
51,382,848102,765,696
77,074,272
No significant difference
detected
Indirect costs Absenteeism (Cross-sectional analyses)
Absenteeism (PAF method)
Human capital approach
215,000,000256,000,000
235,500,000
Absenteeism (PAF method)
Friction cost approach
74,400,00088,600,000
81,500,000
107,022,854186,486,711
147,417,113
Premature mortality (PAF method)
Results
Republic of
Northern Ireland
Ireland
(PPP Irish 2009 €)
Direct costs
€437,081,820
€127,406,641
Indirect costs
€728,968,662
€382,917,113
Total costs
€1,166,050,482
€510,323,754
Results
• In ROI the direct costs represent 38% of total
costs and 2.9% of healthcare spending.
• In NI the direct costs were 25% of total costs
and 2.8% of healthcare spending.
Main contributing conditions to Direct
Healthcare Costs
•
•
•
•
•
Cardiovascular disease
Type II Diabetes
Colon Cancer
Stroke
Gallbladder Disease
Absenteeism ROI
Chronic back pain
57%
Osteoarthritis
18%
Coronary Artery Disease
9%
Hypertension
Diabetes
6%
4%
Stroke
1%
Premature Mortality
• Main drivers of cost were
▫ Cardiovascular Disease (inc Stroke)
▫ Colorectal cancer
▫ Diabetes Type II
Main Recommendations
•
•
•
•
•
•
Urgent Public Health action required
A Population Health wide prevention approach
Targeted action for the very obese is required
Workplace interventions is needed
Extend regulation of the food industry
Significant investment in research
Full list of recommendations
• Available at:
• http://www.safefood.eu/SafeFood/media/SafeFo
odLibrary/Documents/Publications/Research%2
0Reports/Final-Exec-Summary-The-EconomicCost-of-Obesity.pdf
Questions/
Comments?