Benjamin T. Allaire

The lifetime medical cost burden of overweight and obesity: implications for obesity prevention.

This study quantifies age‐specific and lifetime costs for overweight (BMI: 25–29.9), obese I (BMI: 30–34.9), and obese II/III (BMI: >35) adults separately by race/gender strata. We use these results to demonstrate why private sector firms are likely to underinvest in obesity prevention efforts. Not only does the existence of Medicare reduce the economic burden that obesity imposes on private payers, but, from the perspective of a 20‐year‐old obese adult, the short‐term costs of obesity are small. This suggests that legislation that subsidizes wellness programs and/or mandates coverage for obesity treatments might make all firms better off. Ironically, Medicare has a greater incentive to prevent obesity because when an obese 65 year old enters the program, his/her costs are immediate and higher than costs for normal weight individuals.

Individual and aggregate years-of-life-lost associated with overweight and obesity.

This study presents nationally representative estimates of individual and aggregate years‐of‐life‐lost (YLLs) associated with overweight and three categories of obesity separately by age, race, smoking status, and gender strata. Using proportional hazards analysis and data from the National Health Interview Survey (NHIS) Linked Mortality Files, we estimated life expectancies for each BMI strata and quantified YLLs by comparing differences between each strata and the normal BMI reference group. Our results provide further evidence that overweight and mild obesity are not associated with a reduction in life expectancy. However, higher BMI categories are associated with lower expected survival. In aggregate, excess BMI is responsible for ∼95 million YLLs. White females account for more than two‐thirds of the aggregate YLLs. Unless something is done to reduce the rising prevalence of those with BMIs >35, or to mitigate the impact of obesity or its correlates on YLLs, expected life expectancy for US adults may decrease in the future.

Financial implications of coverage for laparoscopic adjustable gastric banding

BACKGROUND Employers and insurers have become increasingly concerned about the cost implications of providing coverage for bariatric procedures. We sought to quantify the costs and potential cost savings resulting from coverage for laparoscopic adjustable gastric banding (LAGB) using a claims analysis. METHODS U.S. healthcare claims data of >7000 LAGB patients and a propensity score-matched control group were used to quantify the costs and potential cost savings resulting from LAGB for the overall surgery-eligible population and for the subset of the surgery-eligible population with diabetes mellitus. The matched control group consisted of those with a morbid obesity diagnosis code and/or a body mass index >35 kg/m(2) as reported in the Health Risk Assessment data. RESULTS Including the related medical payments in the 90 days before and after the procedure, the mean cost of LAGB was approximately

Direct and Indirect Costs and Potential Cost Savings of Laparoscopic Adjustable Gastric Banding Among Obese Patients With Diabetes

20,000. After placement, a modest reduction occurred in the health expenditures relative to the preoperative payments. In the postoperative period, these decreases were maintained for the LAGB sample. In contrast, the payments for the comparison sample continued to increase. As a result, the net cost of coverage for LAGB was reduced to 0 by approximately 4 years after band placement. For those with diabetes, the net costs resulting from LAGB were reduced to 0 in just >2 years. CONCLUSION These results suggest that the LAGB procedure pays for itself within a relatively short period, especially for those with diabetes.

Feeding patterns during the first 2 years and health outcome.

Objective: To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Methods: Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Results: Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from

Incorporating Indirect Costs into a Cost-Benefit Analysis of Laparoscopic Adjustable Gastric Banding

26570 (±

Psychotropic Drug Use Among Preschool Children in the Medicaid Program From 36 States

9000) to

Measuring the Impact of a Continuing Medical Education Program on Patient Blood Pressure

34160 (±

Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.

10380) when indirect costs are included. Conclusion: This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure.

Training providers in hypertension guidelines: Cost-effectiveness evaluation of a continuing medical education program in South Carolina

Low-birth-weight infants, in particular those with birth weights <1,500 g, benefit from fortified breast milk. Low protein intake is critical, because it is limiting growth. Long-term health outcomes in small-for-gestational-age infants from developing countries in relation to their early nutrition still need to be evaluated in controlled trials. Term infants both in developing and developed countries also benefit from exclusive breastfeeding: an analysis of a large dataset of surveys from 20 developing countries (168,000 infants and small children from the Demographic Health Survey, United States Agency for International Development) indicates that exclusive breastfeeding until 6 months is associated with significantly higher weight, length, and lower probability of stunting, wasting, and infections. Nine out of 10 infants still receive breast milk between 6 and 12 months and probability of infections tends to be lower if breastfeeding is continued during that age range. Between 12 and 24 months, when stunting and wasting rates are already high, 7 out of 10 infants still receive breast milk. No associations of feeding patterns with disease outcome can be found. Effectiveness trials of complementary feeding strategies in food-insecure countries are urgently needed. Follow-up until 10 years in a developed country now indicates that an infant population at risk for allergic diseases benefits both from breastfeeding and the use of hypoallergenic formula during the first 4 months of life, when compared to cows milk-based formula: both the cumulative incidences of atopic disease and all allergic diseases are significantly lower.