Economic aspects on obesity. Results from the Swedish obese subjects study

Abstract: Aims: To analyse the patterns of sick leave, disability pension and drug consumption, and the willingness to pay (WTP) for obesity treatment among obese individuals. To estimate indirect obesity-related morbidity costs and direct costs of medication in relation to these costs in the general population. To analyse changes in sick leave, disability pension and hospitalisation rates, hospitalisation costs, pharmaceutical use and costs after surgical and conventional obesity treatment.Methods: Swedish Obese Subjects (SOS) is an ongoing prospective study of obesity. In the SOS registry, 6328 obese individuals have been health examined. The SOS intervention study will compare 2010 surgically treated patients, aged 37-60 years with body mass index (BMI) =34 kg/m2 (men) or =38 kg/m2 (women), over 20 years with a matched conventionally treated obese control group (n=2038).Data on sick leave, disability pensions and hospitalisations were obtained from national registers and information on WTP and prescribed medications from mailed questionnaires. Results: Sick leave and disability pension rates were doubled in obese women compared to the Swedish population. The incremental cost of sick leave and disability pension for the overweight (BMI =28 kg/m2) fraction of the Swedish female population was 3.6 billion Swedish kronor (0.5 billion US dollars) for one year (1994 prices). Compared to randomly selected references (n=958), annual pharmaceutical costs were 77% higher in obese individuals. Average WTP for obesity treatment was twice the monthly income. High WTP was associated with high income, high weight and poor perceived health.Six years after inclusion in the SOS intervention study, the average weight change was -16% in surgically and +1% in conventionally treated patients. Compared with controls, surgically treated patients had 35% more days of sick leave plus disability pension the first year after treatment, but 10% to 14% fewer days during years 2 and 3. Over 6 years, the incremental hospitalisation cost for surgical compared to conventional treatment was approximately 12 000 Swedish kronor (1230 US dollars) per person and year (1996 prices). Surgical obesity treatment decreased diabetes and cardiovascular disease medication costs but increased other medication costs. The average annual pharmaceutical costs were similar in the surgically and conventionally treated groups.Conclusions: Obesity has far-reaching economic implications. The WTP for potential benefits of obesity treatment is comparatively high. Surgical obesity treatment increases hospitalisation costs marginally, it does not influence total costs for prescribed pharmaceuticals but may decrease sick leave and disability pension rates.