ESTIMATING THE INPATIENT ECONOMIC BURDEN OF OBESITY IN GREECE: A NATIONWIDE POPULATION ATTRIBUTABLE FRACTION ANALYSIS USING REAL-WORLD HOSPITAL DATA
Author(s)
Themistoklis Paraskevas, MD1, Michalis Papapanou, MD2, Anastasio Kantanis, MD1, Kostas Athanasakis, PhD3.
1University of Patras, Patras, Greece, 2Second Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 3Laboratory for Health Technology Assessment, Athens, Greece.
1University of Patras, Patras, Greece, 2Second Department of Obstetrics and Gynaecology, Medical School, National and Kapodistrian University of Athens, Athens, Greece, 3Laboratory for Health Technology Assessment, Athens, Greece.
OBJECTIVES: Obesity is a major driver of morbidity, mortality, and healthcare expenditure. However, real-world evidence on obesity-attributable inpatient costs remains limited. This study estimates the burden of obesity-related hospitalizations in Greece from a third-party payer perspective, using population-attributable fractions (PAFs) combined with nationwide hospitalization claims data.
METHODS: A prevalence-based cost-of-illness analysis was conducted using anonymized nationwide hospitalization claims submitted to the Greek third-party payer, covering a full year’s admissions across public and private hospitals (2.4 million admissions). Obesity-related conditions were identified through the Global Burden of Disease (GBD) framework and an additional targeted literature review. Corresponding ICD-10 codes were mapped to each condition. PAFs were derived either from published estimates or calculated using the Levin formula, combining country-specific obesity prevalence and disease-specific relative risks. Hospital costs were assigned to obesity proportionally according to disease-specific PAFs. Costs are reported in 2025 Euros.
RESULTS: Thirty obesity-related conditions identified through the GBD framework and 15 additional conditions from the literature review were included. Obesity-attributable inpatient costs totaled €214.4 million, corresponding to 5.1% of all inpatient expenditure. Cancer represented the largest share of attributable inpatient costs (€75.9 million, 38.4%), followed by cardiovascular diseases (€48.9 million, 24.7%) and musculoskeletal disorders (€38.6 million 19.5%). The largest individual contributors were ischemic heart disease (€30.1 million), knee osteoarthritis (€23.9 million), breast cancer (€15.3 million), congestive heart failure (€13.8 million), and chronic kidney disease (€12.3 million). The attributable cost percentage was lower for public hospitals (4.5%) than private hospitals (5.9%).
CONCLUSIONS: Obesity imposes a substantial and growing economic burden on the Greek healthcare system, accounting for more than one in twenty inpatient Euros spent nationally. The findings highlight the need for comprehensive obesity prevention and management strategies, including earlier intervention and improved risk-factor surveillance. Real-world cost estimates may support future health policy prioritization and economic evaluations of obesity-related interventions in Greece and Europe.
METHODS: A prevalence-based cost-of-illness analysis was conducted using anonymized nationwide hospitalization claims submitted to the Greek third-party payer, covering a full year’s admissions across public and private hospitals (2.4 million admissions). Obesity-related conditions were identified through the Global Burden of Disease (GBD) framework and an additional targeted literature review. Corresponding ICD-10 codes were mapped to each condition. PAFs were derived either from published estimates or calculated using the Levin formula, combining country-specific obesity prevalence and disease-specific relative risks. Hospital costs were assigned to obesity proportionally according to disease-specific PAFs. Costs are reported in 2025 Euros.
RESULTS: Thirty obesity-related conditions identified through the GBD framework and 15 additional conditions from the literature review were included. Obesity-attributable inpatient costs totaled €214.4 million, corresponding to 5.1% of all inpatient expenditure. Cancer represented the largest share of attributable inpatient costs (€75.9 million, 38.4%), followed by cardiovascular diseases (€48.9 million, 24.7%) and musculoskeletal disorders (€38.6 million 19.5%). The largest individual contributors were ischemic heart disease (€30.1 million), knee osteoarthritis (€23.9 million), breast cancer (€15.3 million), congestive heart failure (€13.8 million), and chronic kidney disease (€12.3 million). The attributable cost percentage was lower for public hospitals (4.5%) than private hospitals (5.9%).
CONCLUSIONS: Obesity imposes a substantial and growing economic burden on the Greek healthcare system, accounting for more than one in twenty inpatient Euros spent nationally. The findings highlight the need for comprehensive obesity prevention and management strategies, including earlier intervention and improved risk-factor surveillance. Real-world cost estimates may support future health policy prioritization and economic evaluations of obesity-related interventions in Greece and Europe.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH232
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems