Clinical and Economic Burden of Obesity and Cardiovascular Disease Among Medicare Fee-For-Service Beneficiaries

This retrospective cohort study described clinical outcomes, healthcare resource utilisation (HCRU), and costs among Medicare beneficiaries with or without obesity and stratified by cardiovascular disease (CVD) risk.

Using Medicare FFS claims (Jan 2016-Dec 2022), beneficiaries were indexed after 12 months of continuous enrollment and followed until death, disenrollment, or study end (≥ 12 months continuous enrollment post-index required for HCRU and cost analyses). Outcomes were compared between beneficiaries with obesity (class ≥ 1: diagnosis/BMI ≥ 30; class ≥ 3: severe/morbid obesity/BMI ≥ 40) versus without obesity, and stratified by CVD risk (established, at-risk and low-risk). Time-to-event outcomes were assessed using Cox models, and HCRU and costs using generalised linear models and two-part models, all adjusted for baseline covariates.

A total of 21 306 251 beneficiaries were included in the study. Hazard ratios for clinical outcomes were higher among those with obesity versus without obesity, particularly for heart failure-associated hospitalisation (class ≥ 1: 1.92; class ≥ 3: 3.40), type 2 diabetes (class ≥ 1: 1.65; class ≥ 3: 2.20) and MACE-5 (class ≥ 1: 1.44; class ≥ 3: 2.27). Total costs (per-patient per-month $; cost ratio) were higher among those with obesity class ≥ 1 ($4113 vs. $2876; 1.43), and obesity class ≥ 3 ($5319 vs. $2929; 1.82), driven by high outpatient and inpatient utilisation. Results were consistent across CVD risk stratifications.

These findings highlight the higher risk of negative clinical outcomes and costs associated with obesity among US Medicare beneficiaries. Further research is warranted to improve treatment and prevention of obesity to mitigate risks and costs for this population.