Gesundheitsökonomische Aspekte von Übergewicht und Adipositas

 

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Zusammenfassung

Dieser Beitrag gibt einen Überblick über gesundheitsökonomische Aspekte von Übergewicht und Adipositas. Zunächst werden die Methoden der Messung von direkten und indirekten Krankheitskosten sowie die Ergebnisse von Krankheitskostenstudien aus der internationalen Literatur vorgestellt. In diesen Studien wurde der Anteil der durch Übergewicht und Adipositas verursachten Kosten an den Gesamtkosten der Gesundheitsversorgung meist auf zwei bis sechs Prozent geschätzt. Anschließend wird aufgezeigt, wie mit den Methoden der ökonomischen Evaluation die Kosteneffektivität präventiver Gesundheitsleistungen beurteilt werden kann. Probleme ergeben sich dabei aus der Notwendigkeit der Schätzung langfristiger Auswirkungen auf die Kosten und Effekte einer Vielzahl assoziierter Folgekrankheiten. In der Literatur vorhandene ökonomische Evaluationsstudien präventiver Gesundheitsleistungen weisen auf eine sehr günstige Kosteneffektivität hin. Zur Steigerung der Wirtschaftlichkeit der Gesundheitsversorgung sollten vermehrt kosteneffektive Maßnahmen zur Prävention von Übergewicht und Adipositas entwickelt und eingesetzt werden.

Summary

This article provides an overview of economic aspects of overweight and obesity. After describing the methods of measuring direct and indirect costs, results of cost-of-illness studies from the international literature are presented. In these studies, the proportion of direct health care costs caused by overweight and obesity has been estimated between 2 % and 6 %. Subsequently, this paper describes the methods that can be used to analyse the cost-effectiveness of preventive services. Problems arise from the need to estimate long-term effects of prevention on costs and health consequences of multiple associated diseases. Economic evaluations of preventive services published in the literature often report very favourable cost-effectiveness ratios. In order to increase the efficiency of health care, more costeffective preventive services for overweight and obesity should be developed and used.

• Literatur

• 1 Arterburn DE, Maciejewski ML, Tsevat J. Impact of morbid obesity on medical expenditures in adults. Int J Obes 2005; 29: 334-339.
  CrossrefPubMedGoogle Scholar
• 2 Benecke A, Vogel H. Gesundheitsberichterstattung des Bundes. Heft 16. Übergewicht und Adipositas. Berlin: Robert-Koch-Institut; 2005
  Google Scholar
• 3 Birmingham CL, Muller JL, Palepu A. et al. The cost of obesity in Canada. CMAJ 1999; 160: 483-488.
  PubMedGoogle Scholar
• 4 Briggs AH. Handling uncertainty in cost-effectiveness models. Pharmacoeconomics 2000; 17: 479-500.
  CrossrefPubMedGoogle Scholar
• 5 Brown HS, Perez A, Li YP. et al. The cost-effectiveness of a school-based overweight program. Int J Behav Nutr Phys Act 2007; 04: 47.
  CrossrefPubMedGoogle Scholar
• 6 Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 2003; 348: 1625-1638.
  CrossrefPubMedGoogle Scholar
• 7 Emery C, Dinet J, Lafuma A. et al. Cost of obesity in France. Presse Med 2007; 36: 832-840.
  CrossrefPubMedGoogle Scholar
• 8 Ezzati M, Lopez AD, Rodgers A. et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347-1360.
  CrossrefPubMedGoogle Scholar
• 9 Gold MR, Siegel JE, Russel LB. et al. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996
  Google Scholar
• 10 Gortmaker SL, Must A, Perrin JM. et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329: 1008-1012.
  CrossrefPubMedGoogle Scholar
• 11 Haddix AC, Teutsch SM, Phaedra SC. Prevention effectiveness. Oxford: Oxford University Press; 2003
  Google Scholar
• 12 Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol 2004; 29: 90-115.
  CrossrefPubMedGoogle Scholar
• 13 Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research. Principles and quantitative methods. New York: Van Nostrand Reinhold; 1982
  Google Scholar
• 14 Knai C, Suhrcke M, Lobstein T. Obesity in Eastern Europe: an overview of its health and economic implications. Econ Hum Biol 2007; 05: 392-408.
  CrossrefPubMedGoogle Scholar
• 15 Levy E, Levy P, Le Pen C, Basdevant A. The economic cost of obesity: the French situation. Int J Obes Relat Metab Disord 1995; 19: 788-792.
  PubMedGoogle Scholar
• 16 Long DA, Reed R, Lehman G. The cost of lifestyle health risks: obesity. J Occup Environ Med 2006; 48: 244-251.
  CrossrefPubMedGoogle Scholar
• 17 Mitra A. Affects of physical attributes on the wages of males and females. Appl Econ Lett 2001; 08: 731-735.
  CrossrefPubMedGoogle Scholar
• 18 Must A, Spadano J, Coakley EH. et al. The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523-1529.
  CrossrefPubMedGoogle Scholar
• 19 Odegaard K, Borg S, Persson U, Svensson M. The Swedish cost burden of overweight and obesity – evaluated with the PAR approach and a statistical modelling approach. Int J Pediatr Obes 2008; 03 (Suppl. 01) 51-57.
  CrossrefPubMedGoogle Scholar
• 20 Pagan JA, Davila A. Obesity, occupational attainment, and earnings. Soc Sci Q 1997; 78: 756-770.
  PubMedGoogle Scholar
• 21 Quesenberry Jr CP, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med 1998; 158: 466-472.
  CrossrefPubMedGoogle Scholar
• 22 Rissanen AM. The economic and psychosocial consequences of obesity. Ciba Found Symp 1996; 201: 194-201 discussion 201–206.
  PubMedGoogle Scholar
• 23 Sander B, Bergemann R. Economic burden of obesity and its complications in Germany. Eur J Health Econ 2003; 04: 248-253.
  CrossrefPubMedGoogle Scholar
• 24 Schmid A, Schneider H, Golay A, Keller U. Economic burden of obesity and its comorbidities in Switzerland. Soz Praventivmed 2005; 50: 87-94.
  CrossrefPubMedGoogle Scholar
• 25 Thompson D, Brown JB, Nichols GA. et al. Body mass index and future healthcare costs: a retrospective cohort study. Obes Res 2001; 09: 210-218.
  CrossrefPubMedGoogle Scholar
• 26 Thompson D, Edelsberg J, Colditz GA. et al. Lifetime health and economic consequences of obesity. Arch Intern Med 1999; 159: 2177-2183.
  CrossrefPubMedGoogle Scholar
• 27 Thompson D, Edelsberg J, Kinsey KL, Oster G. Estimated economic costs of obesity to U.S. business. Am J Health Promot 1998; 13: 120-127.
  CrossrefPubMedGoogle Scholar
• 28 Thompson D, Wolf AM. The medical-care cost burden of obesity. Obes Rev 2001; 02: 189-197.
  CrossrefPubMedGoogle Scholar
• 29 Visscher TL, Seidell JC. The public health impact of obesity. Annu Rev Public Health 2001; 22: 355-375.
  CrossrefPubMedGoogle Scholar
• 30 von der Schulenburg. Deutsche Empfehlungen zur gesundheitsökonomischen Evaluation – dritte und aktualisierte Fassung des Hannoveraner Konsens. Gesundh Ökon Qual Manag 2007; 12: 285-290.
  Article in Thieme ConnectPubMedGoogle Scholar
• 31 von Lengerke T, Reitmeir P, John J. Direct medical costs of (severe) obesity: a bottom-up assessment of over- vs. normal-weight adults in the KORAstudy region (Augsburg, Germany). Gesundheitswesen 2006; 68: 110-115.
  Article in Thieme ConnectPubMedGoogle Scholar
• 32 Wang LY, Yang Q, Lowry R, Wechsler H. Economic analysis of a school-based obesity prevention program. Obes Res 2003; 11: 1313-1324.
  CrossrefPubMedGoogle Scholar
• 33 WHO. Obesity: preventing and managing the global epidemic. Report of a WHO consultation on obesity. WHO Technical Report Series 894. Genf: Word Health Organization; 2000
  PubMedGoogle Scholar
• 34 Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res 1998; 06: 97-106.
  CrossrefPubMedGoogle Scholar
• 35 Worre-Jensen AL, Jensen NB, Heitmann BL. et al. The cost of obesity on the Danish health care system. Ugeskr Laeger 2007; 169: 2634-2637.
  PubMedGoogle Scholar