What is the Evidence and Return on Investment (ROI) of Obesity Prevention and Control in Worksite Settings? Ron Z. Goetzel, Ph.D., Johns Hopkins University - Truven Health Analytics GW-ICF Research and Evaluation Forum -- January 21, 2015 -- Washington, DC #GWICF2015
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What is the Evidence and Return on Investment (ROI) of Obesity Prevention and Control in Worksite Settings?
Ron Z. Goetzel, Ph.D., Johns Hopkins University - Truven Health Analytics
GW-ICF Research and Evaluation Forum -- January 21, 2015 --Washington, DC
Q: What problem are we trying to solve? A: Spending a lot of money on sick care!
• The United States spent $3.056 trillion in
healthcare in 2014, or $9,596 for every man,
woman and child.
• Spending by sector
• Private health insurance - $1.102 billion
• Medicare - $615.9 billion
• Medicaid - $507.2 billion
• Out of pocket -- $338.1 billion
• Health expenditures as percent of GDP:
7.2 % in 1970
17.6% in 2014
19.3% in 2023 (projected)
Source: Sisko et al., Health Affairs, 33:10, September 23, 2014, 1841-1850
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WHY IS HEALTH CARE SO EXPENSIVE?
Source: K.E. Thorpe, "The Rise in Health Care Spending and What to Do About It," Health Affairs 24, no. 6 (2005): 1436-1445; and K.E. Thorpe et al., "The Impact of Obesity on Rising Medical Spending," Health Affairs 23, no. 6 (2004): 480-486.
Innovation/advancing technology
(pharmacologic, devices, treatments)
• Newborn delivery costs – five-fold increase from 1987-2002
– NICU, incubators, ventilators, C-sections
• New/better medicines for treating disease
– Depression (SSRI introduction – 45% treated in 1987 to 80% treated in 1997
– Allergies (Claritan, Allegra, …)
• New treatment thresholds
– Blood pressure
– High blood glucose
– Hyperlipidemia
Rise in spending for treated diseases (37%)
Ken Thorpe
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WHY IS HEALTH CARE SO EXPENSIVE? (THORPE - PART 2)
THE BIG PICTURE: OVERALL BURDEN OF ILLNESS BY CONDITION
Using Average Impairment and Prevalence Rates for Presenteeism
($23.15/hour wage estimate)
Source: Goetzel, Long, Ozminkowski, et al. JOEM 46:4, April, 2004)
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HERO II STUDY – PUBLISHED NOV. 2012
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RISK-COST IMPACTS – HERO II EXHIBIT 1 Average Unadjusted And Adjusted Medical Expenditures, In 2009 Dollars, By Risk
Levels
Risk measure
Risk
level
Unadjusted
means ($)
Adjusted
means ($)
Unadjusted
difference
(%)
Adjusted difference
(% )
Depression High 6,207 6,738 59.1 48.0
Lower 3,902 4,553
Blood glucose High 6,532 6,849 70.0 31.8
Lower 3,842 5,196
Blood pressure High 5,264 5,734 27.4 31.6
Lower 4,132 4,356
Body weight High 4,956 5,078 41.7 27.4
Lower 3,498 3,988
Tobacco use High 4,192 4,184 10.8 16.3
Lower 3,784 3,597
Physical inactivity High 4,477 4,582 26.6 15.3
Lower 3,537 3,976
Stress High 5,024 5,249 13.0 8.6
Lower 4,444 4,836
Cholesterol High 4,780 4,913 2.0 -2.5
Lower 4,688 5,037
Nutrition and eating
habits High 3,245 3,261
-23.2 -5.2
Lower 4,226 3,440
Alcohol consumption High 3,857 3,843 -3.94 -9.48
Lower 4,015 4,246
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Individual vs. Population-Based Costs
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Cost Per Capita of Risk Factors
-100
-50
0
50
100
150
200
250
300
350
347
178.6
128.2106.2 104.1
80.8
38.3-6.4 -14 -75.4
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RESEARCH ON RISK-COST RELATIONSHIPS - NOVARTIS
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RISK FACTORS AND PRESENTEEISM (N = 5,875)
RISK-COST RELATIONSHIPS AT PEPSICO
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10%
16%
4%
15% 15%
5%
23%
77%
18%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Perc
enta
ge S
am
ple
with H
igh R
isk
HEALTH RISK PREVALENCE
Biometric Risks Health Behavior RisksPsychosocial Risks
BMI BREAKDOWN BY CATEGORY
25%
44%
22%
7%
3%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
NormalBMI < 25
OverweightBMI 25-30
Class IBMI 30-35
Class IIBMI 35-40
Class IIIBMI 40+
Perc
enta
ge S
am
ple
In E
ach B
MI
Cate
go
ry
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PEPSICO – OVERWEIGHT / OBESE ANALYSIS (N=11,217)
*At least one difference significant at the 0.05 level
Source: Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ. The Relationship between Health Risks and Health and Productivity Costs
among Employees at Pepsi Bottling Group. J Occup Environ Med. 52, 5, May 2010.
Difference between combined overweight/obese categories and normal weight is displayed
Diff =
29%,
$613*
Diff =
58%,
$111*
Diff =
25%,
$987
Diff =
10%,
$28
Diff =
7%,
$49
Diff =
26%,
$186*
• 74% of the
sample is
overweight
or obese
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NHLBI MULTI-CENTER STUDY: ESTIMATED ANNUAL COSTS OF HEALTHCARE UTILIZATION, ABSENTEEISM, AND PRESENTEEISM BY BMI CATEGORY
$1,416
$1,180
$2,034
$229
$1,402
$918
$1,544
$155
$182
$1,200
$872
$1,535
$149
$178
$219
$0 $500 $1,000 $1,500 $2,000 $2,500
Presenteeism
Absenteeism Days
Hospital Admissions
Emergency Room
Visits
Doctor Visits
Normal
Overweight
Obese
*
*
*
*
*
* P < .05
Source: Goetzel RZ, Gibson TB, Short ME, Chu BC, Waddell J, Bowen J, Lemon SC, Fernandez ID, Ozminkowski RJ, Wilson
MG, DeJoy DM. A multi-worksite analysis of the relationships among body mass index, medical utilization, and worker
productivity. J Occup Environ Med. 2010 Jan;52 Suppl 1:S52-8.
CDC Community Guide to Preventive Services Review – AJPM, February 201086 Studies Reviewed
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SUMMARY RESULTS AND TEAM CONSENSUS
Outcome
Body of
Evidence
Consistent
Results
Magnitude of
Effect Finding
Alcohol Use 9 Yes Variable Sufficient
Fruits & Vegetables
% Fat Intake
9
13
No
Yes
0.09 serving
-5.4%
Insufficient
Strong
% Change in Those
Physically Active
18 Yes +15.3 pct pt Sufficient
Tobacco Use
Prevalence
Cessation
23
11
Yes
Yes
–2.3 pct pt
+3.8 pct pt
Strong
Seat Belt Non-Use 10 Yes –27.6 pct pt Sufficient
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Outcome
Body of
Evidence
Consistent
Results Magnitude of Effect Finding
Diastolic blood pressure
Systolic blood pressure
Risk prevalence
17
19
12
Yes
Yes
Yes
Diastolic:–1.8 mm Hq
Systolic:–2.6 mm Hg
–4.5 pct pt
Strong
BMI
Weight
% body fat
Risk prevalence
6
12
5
5
Yes
No
Yes
No
–0.5 pt BMI
–0.56 pounds
–2.2% body fat
–2.2% at risk
Insufficient
Total Cholesterol
HDL Cholesterol
Risk prevalence
19
8
11
Yes
No
Yes
–4.8 mg/dL (total)
+.94 mg/dL
–6.6 pct pt
Strong
Fitness 5 Yes Small Insufficient
SUMMARY RESULTS AND TEAM CONSENSUS
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CDC Community Guide Obesity Review
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SUMMARY RESULTS AND TEAM CONSENSUS
Outcome
Body of
Evidence
Consistent
Results
Magnitude of
Effect Finding
Estimated Risk 15 Yes Moderate Sufficient
Healthcare Use 6 Yes Moderate Sufficient
Worker Productivity 10 Yes Moderate Strong
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WHAT ABOUT ROI?CRITICAL STEPS TO SUCCESS
Reduced Utilization
Risk Reduction
Behavior Change
Improved Attitudes
Increased Knowledge
Participation
Awareness
Financial ROI
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HEALTH AFFAIRS ROI LITERATURE REVIEWBaicker K, Cutler D, Song Z. Workplace Wellness Programs Can Generate Savings. Health Aff (Millwood). 2010; 29(2). Published online 14 January 2010.