November 18, 2013
Obese patients who successfully shed pounds by following a medical weight-loss program may reap the reward of lower medication costs for common comorbidities, new research suggests. The single-center, retrospective study was presented in an oral presentation at Obesity 2013: The Obesity Society Annual Scientific Meeting.
After following the program for an average of 22 weeks, patients who typically had a starting weight of about 250 pounds lost about 44 pounds. They also spent, on average, $70 less a month for medications for 4 common comorbidities: diabetes, hyperlipidemia, hypertension, and gastroesophageal reflux disease (GERD).
This shows that “weight loss in a medically supervised setting has the potential to significantly decrease the medication expenses associated with obesity comorbidities, most of all diabetes,” Clay P. Wiske, a medical student currently at Harvard Business School, in Boston, Massachusetts, told the audience.
“There hasn’t been very much published on the cost of medical weight-management programs…partly because [the programs are] not very homogeneous,” senior author Vincent Pera, MD, from Brown University in Providence, Rhode Island, told Medscape Medical News. “My guess is that no matter how the weight loss is achieved [including by bariatric surgery], you would see these kinds of benefits in medication reduction.”
The research was about “medication cost savings” as opposed to “cost-effectiveness,” he acknowledged, and the calculations did not include the cost of participating in the 5-month program, which was about $2000 per patient. About 2 or 3 insurance companies cover the entire cost, he noted.
The latest obesity guidelines, issued by the Obesity Society last week, stress medically supervised programs as a central tenet for successful weight loss, emphasizing that the evidence shows patients need help to shed the pounds. However, this type of program is very poorly reimbursed at present, at least by the Centers for Medicaid & Medicare Services (CMS) — at a rate of around $20 a visit. Coverage of such programs by private insurers in the United States is patchy; it is hoped the new recommendations will encourage more of them to reimburse such schemes.
Can “Low-Risk” Strategies Cut Costs?
Mr. Wiske told the audience that because many recent studies have looked at potential cost savings following bariatric surgery, “we were curious to see whether we would see savings with interventions that were less risky, such as medically supervised weight loss.”
On average, an obese adult living in the United States pays an estimated $2460 more in annual healthcare costs than his or her thinner counterparts, he said. The researchers hypothesized that the medically supervised weight-loss program offered at the Merriam Hospital in Providence, Rhode Island would lead to a decrease in medication costs.
They retrospectively analyzed data from 589 obese patients who participated in this program between 2009 and 2012 and, importantly, completed at least 16 weeks of treatment.
The patients had a mean age of 49 years and 70% were women. When they entered the program, they were taking an average of 4.6 medications, of which 1.6 were for the studied 4 comorbidities.
At baseline, half of the patients had hypertension, 47% had hyperlipidemia, 44% had GERD, and 20% had diabetes. Some patients did not have any of these comorbidities.
When they enrolled, the patients received counseling about 3 types of 1200-calorie-a day meals:
- Complete meal replacement.
- 800 calories from meal replacements plus one “regular” meal.
- No meal replacements, but instead, a tailored, healthy diet.
The meal replacements were Optifast (Nestle) products, most commonly shakes, said Mr. Wiske. About 20% of patients did not take meal replacements, and the rest were split between the 2 types of meal-replacement plans.
All patients were offered weekly physician visits, weekly weigh-ins, counseling sessions with a dietician and an exercise physiologist, plus group education and discussion sessions.
On average, the patients lost about 17.5% of their initial body weight. The weight loss and medication reduction were similar for the patients in the 3 groups.
The average overall monthly wholesale cost of the studied medications fell from $150 to $77, with the largest reduction coming from the drop in cost of diabetes medications.
A multivariate linear model adjusted for physician visits demonstrated that total weight loss, number of nutrition and exercise counseling sessions attended, previous diagnosis of hypertension and hyperlipidemia, as well as number of initial medications were all positively correlated (P < .05) with percent decrease in monthly wholesale medication costs.
Longer Study Needed
“Future research should focus on the longevity of this effect and should include all healthcare costs,” Mr. Wiske concluded.
In response to a question asking how they were able to get people who weigh 250 pounds to stick to a 1200-calorie diet, he explained that the patients were all highly motivated, and some had entered the program because it was a prerequisite for surgery.
Asked to comment, session moderator Ken Fujioka, MD, from Scripps Clinic, San Diego, California, observed that although this was a retrospective study, “still, it had some interesting points — it showed that if you get weight loss, you can save some money…you save medication cost and you get somebody healthy.” However, the study was short and did not examine all costs.
And recent studies looking at bariatric surgery have been unable to prove long-term overall healthcare cost savings, he noted.
Obesity 2013: The Obesity Society Annual Scientific Meeting. Oral presentation, presented November 14, 2013.