The association between body mass index groups and metabolic comorbidities with healthcare and medication costs: a nationwide biobank and registry study in Finland

Aino Vesikansa; Juha Mehtälä; Katja Mutanen; Annamari Lundqvist; Tiina Laatikainen; Tero Ylisaukko-Oja; Tero Saukkonen; Kirsi H Pietiläinen

doi:10.1080/20016689.2023.2166313

The association between body mass index groups and metabolic comorbidities with healthcare and medication costs: a nationwide biobank and registry study in Finland

J Mark Access Health Policy. 2023 Jan 18;11(1):2166313. doi: 10.1080/20016689.2023.2166313. eCollection 2023.

Authors

Aino Vesikansa¹, Juha Mehtälä¹, Katja Mutanen², Annamari Lundqvist³, Tiina Laatikainen^{3

4

5}, Tero Ylisaukko-Oja^{1

6}, Tero Saukkonen², Kirsi H Pietiläinen⁷

Affiliations

¹ MedEngine Oy, Helsinki, Finland.
² Novo Nordisk Farma Oy, Espoo, Finland.
³ Finnish Institute for Health and Welfare, Helsinki, Finland.
⁴ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
⁵ Joint Municipal Authority for North Karelia Social andHealth Services (Siun Sote), Joensuu, Finland.
⁶ Center for Life Course Health Research, University of Oulu, Oulu, Finland.
⁷ Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki,Helsinki, Finland & Obesity Center, Abdominal Center, Endocrinology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Abstract

Background: The increasing prevalence of obesity imposes a significant cost burden on individuals and societies worldwide.

Objective: In this nationally representative study, the association between body mass index (BMI) groups and the number of metabolic comorbidities (MetC) with total direct costs was investigated in the Finnish population.

Study design, setting, and participants: The study cohort included 5,587 adults with BMI ≥18.5 kg/m² who participated in the cross-sectional FinHealth 2017 health examination survey conducted by the Finnish Institute for Health and Welfare. Data on healthcare resource utilization (HCRU) and drug purchases were collected from national healthcare and drug registers.

Main outcome measure: The primary outcome was total direct costs (costs of primary and secondary HCRU and prescription medications).

Results: Class I (BMI 30.0-34.9 kg/m²) and class II - III (BMI ≥35.0 kg/m²) obesity were associated with 43% and 40% higher age- and sex-adjusted direct costs, respectively, compared with normal weight, mainly driven by a steeply increased comorbidity in the higher BMI groups. In all BMI groups combined, individuals with ≥2 MetCs comprised 39% of the total study population and 60% of the total costs.

Conclusion: To manage the cost burden of obesity, treatment should be given equal consideration as other chronic diseases, and BMIs ≥30.0 kg/m² should be considered in treatment decisions.

Keywords: Body mass index; comorbidities; direct costs; healthcare costs; medication costs; metabolic syndrome; obesity.

Grants and funding

Novo Nordisk funded the study (collection, analyses, and interpretation of the data) and writing of the manuscript. Kirsi Pietiläinen had financial support from the Academy of Finland, grant numbers 272376, 266286, 314383, 335443, Finnish Medical Foundation, Gyllenberg Foundation, Novo Nordisk Foundation, grant numbers NNF10OC1013354, NNF17OC0027232, NNF20OC0060547, Finnish Diabetes Research Foundation, University of Helsinki, Helsinki University Hospital and Government Research Funds.