de Oliveira Michele Lessa, Santos Leonor Maria Pacheco, da Silva Everton Nunes
University of Brasilia, Brasília, Federal District, Brazil.
PLoS One. 2015 Apr 1;10(4):e0121160. doi: 10.1371/journal.pone.0121160. eCollection 2015.
Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems.
To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011.
Public hospitals and outpatient care.
A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web.
Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men.
The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.
肥胖是一个全球性的公共卫生问题，也是多种疾病的风险因素，会对医疗系统造成经济影响。
估算2011年巴西公共卫生系统为20岁及以上成年人中肥胖（体重指数{BMI}≥30kg/m²）和病态肥胖（BMI≥40kg/m²）所产生的直接费用。
公立医院和门诊护理。
采用疾病成本法，基于患病率采用自上而下的方法。计算每种与肥胖相关合并症的成本比例，并使用肥胖患病率计算归因风险。直接医疗费用数据（住院护理、减肥手术、门诊护理、药物和诊断程序）从卫生部信息系统中提取，可在网上获取。
肥胖所致直接费用总计2.696亿美元（占所有中高复杂性医疗保健支出的1.86%）。尽管病态肥胖的患病率比肥胖低18倍，但其成本却占所有肥胖相关成本的23.8%（6420万美元）。2011年巴西减肥手术费用总计1740万美元。女性病态肥胖的成本是男性的五倍。
发现病态肥胖的成本相对高于肥胖的成本。如果当前的流行趋势得不到扭转，巴西肥胖症的患病率在未来几年将逐渐上升，其成本也会增加，这将对巴西公共卫生系统的财务可持续性产生严重影响。
