The impact of Medicare coverage for anti-obesity interventions
Obesity is acknowledged as a critical public health concern in the US. The economic burden of the disease is not insignificant. Estimates vary, but a recent study suggested that in the US, the cost of obesity, and obesity-related treatments, was approximately $427.8 billion in 2014, an amount that has undoubtedly escalated in the years that followed owing to the increasing numbers of individuals with obesity. Using a validated and published microsimulation model, we predicted the budget impact to Medicare if the coverage utilization of anti-obesity interventions becomes higher among the elderly.
Over the next 10 years, Medicare is expected to save $19 billion after a modest coverage utilization, and $21 billion after a more aggressive coverage utilization, with the majority of the savings coming from reduction in ambulatory care (Part B) and prescription drug (Part D) expenditures. Even after an aggressive (67.4%) coverage utilization, the evidence shows ≤8% of all Medicare beneficiaries to receive some form of anti-obesity treatment.
- On average, lifestyle intervention helps elderly who are eligible lose 7.5% of excessive weight per year, and anti-obesity drug combined with lifestyle intervention can help eligible patients lose about 9.7%. Participants regain 1/3 of initial lost weight within 5 years after discontinuation
- Each treated beneficiary is expected to incur direct costs to Medicare of ~$1,700 from covered anti-obesity treatment. Those costs will be offset by improvement in their overall health condition, leading to lower expenditures in ER, ambulatory care, inpatient stays, and Rx, resulting in net savings between $6,700 - $7,100 over 10 years per person
- Across the entire Medicare population suggest medical expense would increase about $120 per beneficiary due to higher coverage utilization. The reduction in the cost of treating obesity complications would be more than enough to offset the increased expense, leading to a net savings of between $300 - $330 per beneficiary over 10 years
Our simulation suggests there are likely to be sizable long-term Medicare budget savings due to higher utilization of anti-obesity interventions (lifestyle interventions and/or anti-obesity medications). Download the whitepaper along with a description of the modeling approach and analysis design.
Wayne Su is a Senior Principal Life Sciences Consultant at IHS Markit
Posted 7 December 2017
Disclosure: This research was sponsored by Novo Nordisk Inc. and Eisai Inc.
- Humira faces up to intense biosimilar competition
- 2018 ISPOR Europe research on IRP
- Our pricing and reimbursement research presented at ISPOR Europe
- ISPOR Europe 2018 Barcelona
- Rapid changes in the global IRP environment
- Mexico facing smaller healthcare tender due to double procurement needs
- Medical supplies to Czech hospitals to be stopped after call to reveal drug prices in tenders
- Italian pharma tendering set for new oversight in two-year outlook
International reference pricing of pharmaceuticals: Apply liberally or use sparingly? See our research from… https://t.co/d7R2S7KZVJ
We are at ISPOR Europe 2018 in Barcelona, Spain! Come see our posters tomorrow at 8:30 PHP359 and PHP48