Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

McQuigg, Maria, Broom, John I., Laws, Rachel, Reckless, John, Noble, Paula, Kumar, Sudhesh, McCrombie, Louise, Lean, Mike, Lyons, Felicity, Mongia, Sarika, Frost, Gary, Quinn, Marney, Barth, Julian H., Haynes, Sarah, Finer, Nick, Haslam, David W., Ross, Hazel, Hole, David, Radziwonik, Steven, Sloan, Billy, Trueman, Paul and O'Reilley, Jacqueline 2008, Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care, Journal of health services research & policy, vol. 13, no. 3, pp. 158-166, doi: 10.1258/jhsrp.2008.007140.

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Title Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care
Author(s) McQuigg, Maria
Broom, John I.
Laws, RachelORCID iD for Laws, Rachel
Reckless, John
Noble, Paula
Kumar, Sudhesh
McCrombie, Louise
Lean, Mike
Lyons, Felicity
Mongia, Sarika
Frost, Gary
Quinn, Marney
Barth, Julian H.
Haynes, Sarah
Finer, Nick
Haslam, David W.
Ross, Hazel
Hole, David
Radziwonik, Steven
Sloan, Billy
Trueman, Paul
O'Reilley, Jacqueline
Journal name Journal of health services research & policy
Volume number 13
Issue number 3
Start page 158
End page 166
Total pages 9
Publisher Sage
Place of publication London, Eng.
Publication date 2008-07
ISSN 1355-8196
Summary Objectives Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention.

Methods Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline.

Results The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up.

Conclusion Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.
Language eng
DOI 10.1258/jhsrp.2008.007140
Field of Research 1117 Public Health And Health Services
1402 Applied Economics
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2008, Sage
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