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首页> 外文期刊>Journal of Health Services Research & Policy >Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care
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Influence of body mass index on prescribing costs and potential cost savings of a weight management programme in primary care

机译：体重指数对基层医疗中体重管理计划的处方费用和潜在费用节省的影响

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Objectives: Prescribed medications represent a high and increasing proportion of UK health care funds. Our aim was to quantify the influence of body mass index (BMI) on prescribing costs, and then the potential savings attached to implementing a weight management intervention. nnMethods: Paper and computer-based medical records were reviewed for all drug prescriptions over an 18-month period for 3400 randomly selected adult patients (18–75 years) stratified by BMI, from 23 primary care practices in seven UK regions. Drug costs from the British National Formulary at the time of the review were used. Multivariate regression analysis was applied to estimate the cost for all drugs and the ‘top ten’ drugs at each BMI point. This allowed the total and attributable prescribing costs to be estimated at any BMI. Weight loss outcomes achieved in a weight management programme (Counterweight) were used to model potential effects of weight change on drug costs. Anticipated savings were then compared with the cost programme delivery. Analysis was carried out on patients with follow-up data at 12 and 24 months as well as on an intention-to-treat basis. Outcomes from Counterweight were based on the observed lost to follow-up rate of 50%, and the assumption that those patients would continue a generally observed weight gain of 1 kg per year from baseline. nnResults: The minimum annual cost of all drug prescriptions at BMI 20 kg/m2 was £50.71 for men and £62.59 for women. Costs were greater by £5.27 (men) and £4.20 (women) for each unit increase in BMI, to a BMI of 25 (men £77.04, women £78.91), then by £7.78 and £5.53, respectively, to BMI 30 (men £115.93 women £111.23), then by £8.27 and £4.95 to BMI 40 (men £198.66, women £160.73). The relationship between increasing BMI and costs for the top ten drugs was more pronounced. Minimum costs were at a BMI of 20 (men £8.45, women £7.80), substantially greater at BMI 30 (men £23.98, women £16.72) and highest at BMI 40 (men £63.59, women £27.16). Attributable cost of overweight and obesity accounted for 23% of spending on all drugs with 16% attributable to obesity. The cost of the programme was estimated to be approximately £60 per patient entered. Modelling weight reductions achieved by the Counterweight weight management programme would potentially reduce prescribing costs by £6.35 (men) and £3.75 (women) or around 8% of programme costs at one year, and by £12.58 and £8.70, respectively, or 18% of programme costs after two years of intervention. Potential savings would be increased to around 22% of the cost of the programme at year one with full patient retention and follow-up. nnConclusion: Drug prescriptions rise from a minimum at BMI of 20 kg/m2 and steeply above BMI 30 kg/m2. An effective weight management programme in primary care could potentially reduce prescription costs and lead to substantial cost avoidance, such that at least 8% of the programme delivery cost would be recouped from prescribing savings alone in the first year.
机译：目标：处方药在英国医疗保健基金中所占比例越来越高。我们的目标是量化体重指数（BMI）对处方费用的影响，然后量化实施体重管理干预措施可能节省的费用。 nn方法：对英国7个地区的23种初级保健实践中3400例由BMI分层的随机选择的成年患者（18-75岁）在18个月内的纸质和计算机医疗记录进行了回顾。审查时使用了英国国家处方药的药品费用。应用多元回归分析估算每个BMI点的所有药物和“十大”药物的成本。这样就可以在任何BMI上估算总的和应占的处方费用。在体重管理计划（配重）中实现的减肥结果用于模拟体重变化对药物成本的潜在影响。然后将预期的节省与成本计划的交付进行了比较。对在12和24个月以及有意治疗的随访数据的患者进行分析。配重的结果基于观察到的50％失访率，并假设这些患者将从基线开始每年继续观察到一般体重增加1公斤。结果：BMI 20 kg / m2时，所有处方药的最低年度费用为男性50.71英镑，女性62.59英镑。每增加一个BMI，成本就会增加5.27英镑（男性）和4.20英镑（女性），达到25的BMI（男性77.04英镑，女性78.91英镑），然后分别增加7.78英镑和5.53英镑至BMI 30 （男性115.93英镑，女性111.23英镑），然后是BMI 40的8.27英镑和4.95英镑（男性198.66英镑，女性160.73英镑）。 BMI增加与前十种药物的成本之间的关系更为明显。最低成本为20的BMI（男性为8.45英镑，女性为7.80英镑），高于BMI 30（男性为23.98英镑，女性为16.72英镑），最高为BMI 40（男性为63.59英镑，女性为27.16英镑）。超重和肥胖的可归因成本占所有药物支出的23％，而肥胖则占16％。该计划的成本估计约为每位患者60英镑。对通过配重重量管理计划实现的减轻体重进行建模，可能会在一年内将处方费用减少6.35英镑（男性）和3.75英镑（女性），或计划成本的8％左右，分别降低12.58英镑和8.70英镑，或18两年干预后的计划费用百分比。通过全面的患者保留和随访，第一年的潜在节省将增加到该计划成本的22％左右。 nn结论：药物处方从BMI最低的20 kg / m2上升到BMI的30 kg / m2的急剧上升。在初级保健中有效的体重管理计划可以潜在地减少处方费用并避免大量费用，因此，仅在第一年就可以通过节省费用来弥补至少8％的计划交付费用。

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