IHS Markit , Washington , DC , USA.
Novo Nordisk, Inc , Plainsboro , NJ , USA.
J Med Econ. 2019 Oct;22(10):1096-1104. doi: 10.1080/13696998.2019.1652185. Epub 2019 Aug 19.
To estimate the long-term budget impact of expanding Medicare coverage of anti-obesity interventions among adults aged 65 and older in the US. This study analyzed a representative sample of Medicare beneficiaries from the combined 2008-2016 National Health and Nutrition Examination Surveys. Population characteristics, cost and effectiveness of anti-obesity interventions, and the sustainability of weight loss in real-life were modeled to project the budgetary impact on gross Medicare outlay over 10 years. Hypothetical scenarios of 50% and 67% increases in intervention participation above base case were used to model moderate and extensive Medicare coverage expansion of intensive behavior therapy and pharmacotherapy. For each Medicare beneficiary receiving anti-obesity treatment, we estimate Medicare savings of $6,842 and $7,155 over 10 years under moderate and extensive coverage utilization assumptions, respectively. The average cost of intervention is $1,798 and $1,886 per treated participant. Taking the entire Medicare population (treated and untreated) into consideration, the estimated 10-year budget savings per beneficiary are $308 and $339 under moderate and extensive assumptions, respectively. Sensitivity analysis of drug adherence rate and weight-loss efficacy indicated a potential variation of budget savings within 7% and 22% of the base case, respectively. Most of the projected cost savings come from lower utilization of ambulatory services and prescription drugs. Due to the scarcity of studies on the efficacy of pharmacotherapy among older adults with obesity, the simulated weight loss and long-term maintenance effects were derived from clinical trial outcomes, in which older adults were mostly excluded from participation. The model did not include potential side-effects from anti-obesity medications and associated costs. This analysis suggests that expanding coverage of anti-obesity interventions to eligible individuals could generate $20-$23 billion budgetary savings to Medicare over 10 years.
估算美国 65 岁及以上老年人医疗保险扩大抗肥胖干预措施覆盖范围的长期预算影响。本研究分析了来自 2008 年至 2016 年全国健康和营养调查综合数据的医疗保险受益人的代表性样本。对人口特征、抗肥胖干预措施的成本和效果以及现实生活中减肥的可持续性进行建模，以预测在 10 年内对医疗保险总支出的预算影响。使用基础案例中干预参与率增加 50%和 67%的假设情景来模拟强化行为疗法和药物治疗的中等和广泛的医疗保险覆盖范围扩大。对于接受抗肥胖治疗的每位医疗保险受益人，我们估计在中等和广泛覆盖利用率假设下，10 年内医疗保险可节省 6842 美元和 7155 美元。每个接受治疗的参与者的干预成本为 1798 美元和 1886 美元。考虑到整个医疗保险人群（接受和未接受治疗的人群），在中等和广泛假设下，每位受益人的估计 10 年预算节省分别为 308 美元和 339 美元。药物依从率和减肥效果的敏感性分析表明，预算节省的潜在变化在基础案例的 7%和 22%之间。大部分预测的成本节约来自于减少门诊服务和处方药的使用。由于肥胖的老年人群中药物治疗效果的研究相对较少，模拟的减肥和长期维持效果来自临床试验结果，其中老年人大多被排除在参与之外。该模型不包括抗肥胖药物的潜在副作用和相关成本。本分析表明，将抗肥胖干预措施的覆盖范围扩大到符合条件的个人，可在 10 年内为医疗保险节省 200 亿至 230 亿美元的预算。
