Bjornson Alison M, Szabo Shelagh M, Donato Bonnie M K, Gardner Megan, Kuti Effie
Broadstreet Health Economics & Outcomes Research, Vancouver, BC, Canada.
Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT.
J Manag Care Spec Pharm. 2025 Sep;31(9):851-861. doi: 10.18553/jmcp.2025.25051. Epub 2025 Jul 17.
One hundred million American adults are living with obesity; 75% also have obesity-related complications. Related medical spending exceeds $261 billion dollars. A contemporary synthesis of evidence on the average, per person cost for people living with obesity (PwO) and the impact of obesity-related complications in the United States is lacking.
To summarize estimates of direct medical costs among PwO by obesity severity and presence of obesity-related complications and to characterize the impact of weight loss on direct medical cost savings.
A systematic literature review was implemented in MEDLINE/EMBASE on February 21, 2023, identifying observational studies and economic models published since 2012 reporting on direct medical costs among US PwO. Identified studies were screened; outcomes including all-cause and obesity-specific direct medical costs were extracted. Direct medical costs data were summarized overall, by obesity severity (class I, II, or III), and by the presence of obesity-related complications. Impact on cost savings with weight loss was also summarized. Where possible, comparisons with normal weight cohorts, obesity-related complications subgroups, and treated and untreated groups were explored.
From 9,725 records identified, 32 studies (6.0%) were deemed eligible, all reporting all-cause, direct medical cost estimates. For mean costs per person per year (PPPY) by obesity severity (n = 15 studies), findings relative to a normal weight cohort (n = 11 studies) indicated total costs among PwO ranged from 1.1-fold (class I) to 3.3-fold (class III) higher. For costs by the presence of obesity-related complications (n = 7 studies; relative to an "obesity-only" group) costs were up to 5-fold greater among PwO with both type 2 diabetes and hypertension. Substantial savings were associated with 5% weight loss over 1 year (n = 5 studies). When costs among PwO using obesity medications (OMs) were compared with those among eligible nonusers (n = 3 studies), in 1 study OM users incurred lower costs than nonusers after 2 years. When mean costs among adults undergoing weight loss surgery were compared with nonsurgery controls (n = 5 studies), there was no associated reduction in cumulative total costs across the study periods.
Evidence from this review indicates that direct medical costs among PwO increase with increasing obesity severity and development of obesity-related complications. Although cost savings were observed with 5% weight loss, uncertainty surrounding cost savings accounting for the cost of more recently approved interventions remains. Furthermore, current evidence is lacking, and longitudinal studies considering a wider range and overlap of obesity-related complications are needed to help document and quantify the current direct cost burden of obesity.
1亿美国成年人患有肥胖症；其中75%还患有与肥胖相关的并发症。相关医疗支出超过2610亿美元。目前缺乏关于美国肥胖症患者（PwO）的人均成本以及肥胖相关并发症影响的当代证据综合。
总结按肥胖严重程度和肥胖相关并发症的存在情况划分的PwO直接医疗成本估计值，并描述体重减轻对直接医疗成本节省的影响。
2023年2月21日在MEDLINE/EMBASE上进行了系统的文献综述，确定了自2012年以来发表的关于美国PwO直接医疗成本的观察性研究和经济模型。对识别出的研究进行筛选；提取包括全因和肥胖特异性直接医疗成本在内的结果。直接医疗成本数据按总体、肥胖严重程度（I、II或III级）以及肥胖相关并发症的存在情况进行了总结。还总结了体重减轻对成本节省的影响。在可能的情况下，探索了与正常体重队列、肥胖相关并发症亚组以及治疗组和未治疗组的比较。
从识别出的9725条记录中，32项研究（6.0%）被认为符合条件，所有研究均报告了全因直接医疗成本估计值。对于按肥胖严重程度划分的每人每年平均成本（PPPY）（n = 15项研究），相对于正常体重队列（n = 11项研究）的数据表明，PwO的总成本比正常体重队列高1.1倍（I级）至3.3倍（III级）。对于有肥胖相关并发症的成本（n = 7项研究；相对于“仅肥胖”组），同时患有2型糖尿病和高血压的PwO的成本高出5倍。1年内体重减轻5%可带来可观的成本节省（n = 5项研究）。将使用肥胖药物（OMs）的PwO的成本与符合条件的未使用者的成本进行比较时（n = 3项研究），在1项研究中，OM使用者在2年后的成本低于未使用者。将接受减肥手术的成年人的平均成本与非手术对照组进行比较时（n = 5项研究），在整个研究期间累计总成本没有相应降低。
本次综述的证据表明，PwO的直接医疗成本随着肥胖严重程度的增加和肥胖相关并发症的出现而增加。尽管体重减轻5%可节省成本，但考虑到最近批准的干预措施的成本，成本节省方面仍存在不确定性。此外，目前缺乏证据，需要进行考虑更广泛范围和肥胖相关并发症重叠情况的纵向研究，以帮助记录和量化当前肥胖的直接成本负担。
