The Effects of Incremental Costs of Smoking and Obesity on Health Care Costs Among Adults: A 7-Year Longitudinal Study

Objective: To provide the simultaneous 7-year estimates of incremental costs of smoking and obesity among employees and dependents in a large health care system. Methods: We used a retrospective cohort aged 18 years or older with continuous enrollment during the study period. Longitudinal multivariate cost analyses were performed using generalized estimating equations with demographic adjustments. Results: The annual incremental mean costs of smoking by age group ranged from $1274 to $1401. The incremental costs of morbid obesity II by age group ranged from $5467 to $5530. These incremental costs drop substantially when comorbidities are included. Conclusions: Obesity and smoking have large long-term impacts on health care costs of working-age adults. Controlling comorbidities impacted incremental costs of obesity but may lead to underestimation of the true incremental costs because obesity is a risk factor for developing chronic conditions.

[1]  E. Finkelstein,et al.  National medical spending attributable to overweight and obesity: how much, and who's paying? , 2003, Health affairs.

[2]  Nilay D Shah,et al.  Effect of multiple chronic conditions among working-age adults. , 2011, The American journal of managed care.

[3]  C. Ferguson.  A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States , 2010 .

[4]  A. Basu,et al.  Estimating marginal and incremental effects on health outcomes using flexible link and variance function models. , 2005, Biostatistics.

[5]  P. Fishman,et al.  Health care costs among smokers, former smokers, and never smokers in an HMO. , 2003, Health services research.

[6]  E. Finkelstein,et al.  Annual medical spending attributable to obesity: payer-and service-specific estimates. , 2009, Health affairs.

[7]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[8]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[9]  W. Pan.  Akaike's Information Criterion in Generalized Estimating Equations , 2001, Biometrics.

[10]  R. Sturm,et al.  The effects of obesity, smoking, and drinking on medical problems and costs. , 2002, Health affairs.

[11]  F. Hu,et al.  Comparison of Self‐reported and Measured BMI as Correlates of Disease Markers in U.S. Adults , 2007, Obesity.

[12]  T. Hodgson,et al.  Medical costs of smoking in the United States: estimates, their validity, and their implications , 1999, Tobacco control.

[13]  B. Arondekar,et al.  Scale of interest versus scale of estimation: comparing alternative estimators for the incremental costs of a comorbidity. , 2006, Health economics.

[14]  A. Chiolero,et al.  Obesity in Switzerland: do estimates depend on how body mass index has been assessed? , 2008, Swiss medical weekly.

[15]  E. Finkelstein,et al.  Indirect costs of obesity: a review of the current literature , 2008, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[16]  Edward C. Chao,et al.  Generalized Estimating Equations , 2003, Technometrics.

[17]  J Tsevat,et al.  Impact of morbid obesity on medical expenditures in adults , 2005, International Journal of Obesity.

[18]  David Cutler,et al.  Workplace wellness programs can generate savings. , 2010, Health affairs.

[19]  Terry F. Pechacek,et al.  Smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 2000-2004. , 2008, MMWR. Morbidity and mortality weekly report.