From: Cost analyses of obesity in Canada: scope, quality, and implications
Author, year | (Finkelstein 2001)[24] | (Patra, Popova et al. 2007)[23] | (Birmingham, Muller et al. 1999)[22] | (Tarride, Haq et al. 2012)[27] | (Janssen, Lam et al. 2009 2[8] | (Katzmarzyk and Janssen 2004)[28] | (Moffatt, Shack et al. 2011)[26] | (Anis, Zhang et al. 2009)[11] | (Kuhle, Kirk et al. 2011)[7] | (Ohinmaa, Langille et al. 2011)[21] |
---|---|---|---|---|---|---|---|---|---|---|
QHES score | 82 | 77 | 86 | 94 | 85 | 85 | 85 | 97 | 94 | 91 |
Year of cost determination | 1994 | 1997 | 1997 | 2000 | 2000 | 2001 | 2005 | 2006 | 2006 | 2009 |
Settings | Ontario | Canada | Canada | Ontario | Ontario | Canada | Canada | Canada | Nova Scotia | Nova Scotia |
Objective regarding costs | To compute direct estimates of the costs of physicians' services in Ontario in relation to Body Mass Index (BMI) and smoking | To estimate the economic cost of chronic disease in Canada | To estimate the direct costs related to the treatment of and research into Obesity in Canada in 1997. | To present an overview of the human and economic burden associated with BMI categories in Ontario, Canada, costs associated with hospitalization, same day procedures and physician visits | To perform an obesity cost-of-illness analysis for individuals living in the province of Ontario, Canada | To estimate the direct and indirect economic costs of physical inactivity and obesity in Canada in 2001 | To estimate the direct and indirect costs associated with overweight and obesity | To estimate the economic burden of illness because of overweight and obesity in Canada | To assess health service use and costs across categories of weight status | To estimate the costs associated with implementing and maintaining comprehensive school health. |
Approach | Prevalence-based | Prevalence-based | Prevalence-based | Prevalence-based | Prevalence-based | Prevalence-based | Prevalence-based | Prevalence-based | Incidence-based | Top-down costing |
Data source | NPHS 1995/6. | Literature searches | - NPHS 1994/5. | - CCHS 1.1. | - CCHS 2000-1. | - CCHS 2001. | - CCHS 2004/5. | - National Health Expenditure Database. | 2003 Children’s Lifestyle and School Performance Study (CLASS). | Accounting information of all schools in the Annapolis Valley Health Promoting Schools (AVHPS) |
Ontario Health Insurance Plan. | Â | - EBIC 1993. | - Ontario Health Insurance Program (OHIP). | - Ontario Health Insurance Plan (OHIP). | - EBIC 1993, 1998. | - NPHS, CCHS, Literature searches (RRs). | - EBIC. | Medical Services Insurance database | ||
 |  | - Health expenditure from Health Canada. | - Discharge Abstract Database, Inpatient and Day Procedure. |  |  | - EBIC 2000. |  | .CIHI Discharge Abstract Database. | ||
 |  |  |  |  |  |  |  | Nova Scotia Atlee Perinatal Database. |  | |
Number of comorbidities | Â | 8 | 10 | Â | Â | 8 | 22 | 18 | Â | Â |
Sample size | 2,170 | Â | Â | 28,797 | 27,478 | Â | Â | Â | 4,380 | Â |
Perspective | Third-party payer | Societal | Societal | provincial health system | third-party payer | Societal | Societal | Societal | Provincial health care system. | Program manager |
Direct Costs | Physician Costs | hospital care, specialized treatment, physician care, prescription drugs, and additional direct health expenditures | Hospital care, physician services, services of other health professionals, drugs, other health care and health research. | DAD-IP: costs of inpatient hospital stays. | Physician | hospital care expenditures, drug expenditures, physician care expenditures, costs for care in other institutions, and additional direct health expenditures | Hospital care, drugs, physician care, institutional care, and additional direct costs such as capital investments, public health, and research. | Hospital care, physician services, services provided by other health professionals, drugs, health research and other health care | MSI: physician (incl. emergency room visits) Aggregate costs of health care episodes for physician (birth-2006) visits and hospitalizations (2003-2006) | Â |
DAD-DP: costs of day procedures. | Â | |||||||||
OHIP: physicians and nonhospital Laboratories costs. | Â | |||||||||
Indirect costs | Â | Mortality costs, morbidity costs due to long and short-term disability. | Â | Â | Â | Mortality costs, morbidity costs due to long and short-term disability | Morbidity costs due to long and short-term disability. | Morbidity costs due to long and short-term disability. | Â | Â |
Strengths/ Limitations in Costs Estimates | Insufficient direct costs and indirect costs. | Not available. | Indirect cost excluded. | Drug costs, costs associated with other non-physician healthcare providers or indirect costs were not included.. | Insufficient direct costs (only physician cost). Indirect costs were not included. | Both direct and indirect costs included. | Excluded costs: | Meta-analysis of relative risks of chronic conditions. | Lack of drug prescription costs. | Donations, volunteers contribution were not fully recorded and costed. |
 | Direct measures at individual level. | Direct measures at individual level |  | Meta-analysis of relative risks of chronic conditions | Out-of-pocket costs not reimbursed, morbidity costs. |  | Direct measures at individual level. |  | ||
 | Self-reported BMI |  | Self-reported BMI. | Self-reported BMI. | Self-reported BMI | Measured BMI. | Measured BMI. | Measured BMI. | Measured BMI. |  |
 |  |  |  | Overweight (BMI>=25) – 35 % | Adults – Overweight – 35. 85% | Obese (BMI>=30) - 14.7% | Overweight (BMI>=25) - 35.7% | Overweight (BMI>=25) | Overweight (BMI>=25) – 23% |  |
Obesity measures and prevalence | Overweight and Obese - 58.6% | Not stated. | Obese (BMI>=27) – 13.5% | Obese (BMI>=30) - 17% | Obese – 16.95%Adolescents - Overweight – |  | Obese (BMI>=30) - 25.2%; | Obese (BMI>=30). | Obese (BMI>=30) - 10% |  |
 |  |  |  | 15%Obese – 5.3% |  |  |  |  |  | |
Results | $65 M | The total direct cost of obesity in Canada in 1997 was estimated to be between $2.1 billion to $11 billion (or between $64.4 and $343.4 per capita) ~ 2.4% to 12% of the total health care expenditures. | Total direct cost: $1.8 B (0.8-3.5 B) ~2.4% of the total direct health care expenditures in Canada in 1997. | One year total physician, hospitalization, day procedure costs: Normal: $708.0 ($668.2, $752.4) | Adults: Overweight: Male: 427 (397, 457) $/y, Female: 578 (542, 613) $/y ; Obese: Male: 475 (434, 518) $/y, Female: 682 (639, 736) $/y. | Physical inactivity (2.6% total health care costs in Canada): Total: $5.3 B; Direct: $1.6 B; Indirect: $3.7 B | Total $1.27 B. | Direct Costs - $ 6.0 B (65.7% attributable to Obesity) ~ 4.1% of the total direct health expenditures in Canada in 2006. | Population: 295 (133; 629); Normal weight: 275 (128; 598); Overweight: 298 (136; 600); Obese: 356 (140; 721). | The annual public funding to AVHPS to implement and maintain CSH totaled $344,514, which translates, on average, to $7,830 per school and $22.67 per student |
The mean per capita cost of physicians' services in Ontario increased by $8.90 (95% CI: $1.90-$15.60) for each unit increase in BMI | Underweight: $746.0 ($652.0, | Adolescents: Comparable for normal-weight and overweight/ obese ($233/ y) | Obesity (2.2% total health care costs in Canada): Total: $4.3 B; Direct: $1.6 B; Indirect: $2.7 B. | Direct cost: $630.1M | Indirect Costs - $5.0 B ~4.2% total health expenditure in Canada in 2006. | Lifetime physician cost: Population: 2201 (1 449; 3 370) ; Normal weight: 2147 (1 428; 3 297) ; Overweight: 2309 (1 463; 3 315) ; Obese: 2504 (1 694; 3 725) | ||||
Indirect cost: $643.8M | ||||||||||
 |  |  |  | Overweight: $690.3 ($648.2, $736.4) |  |  |  |  |  |  |
 |  |  |  | Obesity: $884.1 ($806.1, $953.8) |  |  |  |  |  |  |