Tackling Obesity in England - National Audit Office

TACKLING OBESITY IN ENGLAND19 There were relatively few hospital admissions oroutpatient attendances specifically for obesity: just over6,000, at a total cost of £1.8 million. The costs of drugsprescribed for weight loss was £0.8 million in 1998. Itshould be noted, however, that the gastro-intestinaldrug, Orlistat - which accounted for 85% of the total -was not licensed for use in the United Kingdom until thelast quarter of 1998. This suggests that the annual cost ofprescriptions in 1999 and beyond is likely to beconsiderably higher.Cost of treating the consequences of obesity20 We estimated the cost of treating the disease attributableto obesity to be £469.9 million (Figure 33).21 By far the biggest contributors to this cost were coronaryheart disease (angina pectoris and myocardialinfarction), Type 2 diabetes, and hypertension, whichtogether accounted for over 80 per cent of the total. Thenext most significant contributors were osteoarthritis,stroke, gall-bladder disease and colon cancer.22 There are a number of potentially important diseaseareas that were excluded from this analysis because of alack of data to allow us to estimate the proportion oftreatment costs that could be attributed to obesity. Forexample, depression, hyper-lipidemia and back painwere not included because no studies were identified inthe systematic review that reported the relative risk for33The costs of treating the consequences of obesity in England in 1998obese individuals of developing these conditions. Thisdoes not mean that obesity is not an important riskfactor for these conditions. Even a small proportion ofthe cost of antidepressants (£279m in 1998) and lipidregulatingdrugs (£190m in 1998) would significantlyincrease the estimate of direct costs.23 There are three further limitations to the analysis. Firstly,while the most widely accepted definition of obesity (abody mass index of 30kg/m 2 or above) was used as faras possible, some of the disease-specific studies fromwhich relative risk was taken had applied different cutoffpoints to define the obese and non-obese groups.This may have led to a degree of over- or underestimationof the obesity-attributable costs of particulardiseases, but there is no discernible bias either way inthe overall approach taken.24 Secondly, the data on relative risk for most associateddiseases were taken from international studies due to alack of comparable data in the United Kingdom.International studies will only give truly reliableindicators where the characteristics of the studypopulation broadly match the characteristics of theEnglish population. All but one of the studies used in theanalysis were undertaken in North America or WesternEurope. While the extent to which the same relative risksapply to the English population is uncertain, theynevertheless represent the best data available on whichto base relative risk estimates.Attributable cases Cost of General Cost of hospital Cost of Total cost Proportion of(% of total cases) Practitioner consultations contacts 1 prescriptions (£m) total costs (%)(£m) (£m) (£m)Hypertension 794,276 (36) 25.5 7.7 101.6 134.8 29Type 2 diabetes 270,504 (47) 7.9 36.7 78.9 123.5 26Angina pectoris 90,776 (15) 2.8 35.3 46.6 84.7 18Myocardial infarction 28,027 (18) 0.6 41.6 0.0 42.2 9Osteoarthritis 194,683 (12) 4.7 14.5 15.6 34.8 7Stroke 20,260 (6) 0.5 15.7 0.5 16.7 4Gallstones 8,384 (15) 0.2 10.2 0.4 10.8 2Colon cancer 7,483 (29) 0.4 10 0.0 10.4 2Ovarian cancer 1,543 (13) 0.1 3.8 0.1 4.0 1Gout 96,549 (47) 2.2 0.0 1.7 3.9 1Prostate cancer 809 (3) 0.0 0.9 1.7 2.6 1Endometrial cancer 834 (14) 0.0 1.1 0.1 1.2 0Rectal cancer 126 (1) 0.0 0.2 0.1 0.3 0Total 44.9 177.7 247.3 469.9 100appendix sixNote 1. Ordinary admissions, day cases and outpatient attendances combined59