HEALTHCARE RESOURCE UTILIZATION AND INCIDENCE OF OBESITY-RELATED COMPLICATIONS ACROSS BMI CLASSES: A MULTI-COUNTRY FEDERATED STUDY (COST-O)
Author(s)
Evgeniya Novoderezhkina, PhD1, Soutrik Banerjee, PhD1, Emily Wilkes, MSc1, Beatriz Bonamichi, PhD1, Gabriela Cardenas, PhD2, Ghada Abu-Sheasha, PhD2, Milou Brand, PhD2, Eva Oakkar, PhD2, Lieven Annemans, PhD3, Gema Fruhbeck, MD, PhD4, John Wilding, DM FRCP5.
1Eli Lilly and Company, Indianapolis, IN, USA, 2IQVIA Inc., London, United Kingdom, 3Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium, 4Department of Endocrinology & Nutrition, Clinica Universidad de Navarra, CIBEROBN, Pamplona, Spain, 5Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom.
1Eli Lilly and Company, Indianapolis, IN, USA, 2IQVIA Inc., London, United Kingdom, 3Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium, 4Department of Endocrinology & Nutrition, Clinica Universidad de Navarra, CIBEROBN, Pamplona, Spain, 5Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, United Kingdom.
OBJECTIVES: Estimate the incidence of healthcare resource utilization (HCRU) and obesity-related complications (ORCs) across body mass index (BMI) categories.
METHODS: COST-O is a retrospective, observational, cohort study using federated healthcare databases from 2021 to 2025 (study period) from the UK and Japan. Adults (≥18 years) with a first BMI record (index date) during the study period were eligible; those with missing sex or age, prior bariatric surgery, current pregnancy, or unintentional weight loss-related conditions were excluded. Event rates per 100 person-years (100PY) with 95% confidence intervals were estimated. ORCs were classified as acute or chronic; chronic ORCs were excluded from incidence analysis if patients had a record of the same ORC during the look-back period (from January 2018).
RESULTS: Across BMI categories and countries, COST-O included 1,875,943 individuals. Median age ranged from 34 to 46 years, with the female proportion ranging from 40.4 to 61.8% in the UK and 42 to 56 years, with 41.0 to 53.8% female in Japan. Type 2 diabetes (T2D) and dyslipidemia were common baseline ORCs. HCRU per 100PY increased with BMI, e.g. primary care and outpatient visits ranged from 197.28 to 331.94 and from 363.82 to 591.68, respectively (UK); and outpatient visits and hospitalizations ranged from 792.14 to 894.40 and 3.37 to 4.92, respectively (Japan). Overall, ORC incidences per 100PY increased with BMI, e.g. incidence in normal BMI versus Class III obesity were, for T2D: 0.49 vs 4.09 (UK) and 7.19 vs 19.60 (Japan); dyslipidemia: 0.86 vs 1.34 (UK) and 6.00 vs 11.75 (Japan); MASLD/MASH: 0.19 vs 1.52 (UK) and 0.84 vs 4.04 (Japan); OSA: 0.05 vs 1.26 (UK) and 0.27 vs 2.92 (Japan).
CONCLUSIONS: Higher BMI was associated with greater HCRU and ORC event rates, underscoring obesity as a progressive disease requiring earlier, sustained interventions to prevent worsening morbidity and reduce HCRU.
METHODS: COST-O is a retrospective, observational, cohort study using federated healthcare databases from 2021 to 2025 (study period) from the UK and Japan. Adults (≥18 years) with a first BMI record (index date) during the study period were eligible; those with missing sex or age, prior bariatric surgery, current pregnancy, or unintentional weight loss-related conditions were excluded. Event rates per 100 person-years (100PY) with 95% confidence intervals were estimated. ORCs were classified as acute or chronic; chronic ORCs were excluded from incidence analysis if patients had a record of the same ORC during the look-back period (from January 2018).
RESULTS: Across BMI categories and countries, COST-O included 1,875,943 individuals. Median age ranged from 34 to 46 years, with the female proportion ranging from 40.4 to 61.8% in the UK and 42 to 56 years, with 41.0 to 53.8% female in Japan. Type 2 diabetes (T2D) and dyslipidemia were common baseline ORCs. HCRU per 100PY increased with BMI, e.g. primary care and outpatient visits ranged from 197.28 to 331.94 and from 363.82 to 591.68, respectively (UK); and outpatient visits and hospitalizations ranged from 792.14 to 894.40 and 3.37 to 4.92, respectively (Japan). Overall, ORC incidences per 100PY increased with BMI, e.g. incidence in normal BMI versus Class III obesity were, for T2D: 0.49 vs 4.09 (UK) and 7.19 vs 19.60 (Japan); dyslipidemia: 0.86 vs 1.34 (UK) and 6.00 vs 11.75 (Japan); MASLD/MASH: 0.19 vs 1.52 (UK) and 0.84 vs 4.04 (Japan); OSA: 0.05 vs 1.26 (UK) and 0.27 vs 2.92 (Japan).
CONCLUSIONS: Higher BMI was associated with greater HCRU and ORC event rates, underscoring obesity as a progressive disease requiring earlier, sustained interventions to prevent worsening morbidity and reduce HCRU.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE632
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)