A retrospective analysis of health care utilization and costs by body mass index category among adults with, or at risk of, cardiovascular disease

BACKGROUND: There is a need for more real-world evidence to better understand the long-term effect of excess weight on health care resource utilization (HCRU) and costs over time among people at risk for atherosclerotic cardiovascular disease (ASCVD) (primary prevention population) and those with established ASCVD (secondary prevention population). OBJECTIVE: To describe all-cause HCRU and costs during a 5-year follow-up period, stratified by body mass index (BMI) category among commercially insured US adults at risk of or with known ASCVD in both primary and secondary prevention populations. METHODS: This retrospective cohort study used Optum administrative claims and electronic health record (EHR) data from January 1, 2007, to December 31, 2023 (study period). Included adult patients had at least 1 BMI measure in the identification period (January 1, 2008, through December 31, 2018), with the date of the first BMI measure being the index date. Patients had to have continuous health plan enrollment on a commercial insurance plan and EHR clinical activity for 12 months before index (baseline period) and 5 years after index (follow-up period). Patients were assigned to the primary prevention cohort if there was evidence of ASCVD risk factors, and patients with evidence of ASCVD conditions were assigned to the secondary prevention cohort. Cohort-specific results were reported by BMI category. The outcomes of interest were all-cause HCRU and costs. Descriptive results were reported, and adjusted cost ratios were calculated using multivariable modeling with repeated measures. RESULTS: A total of 26,430 patients were included in the primary prevention cohort (37.9% female, 73.5% non-Hispanic White, and mean [SD] age = 53.9 [9.0] years), and 9,020 patients were included in the secondary prevention cohort (28.9% female, 73.9% non-Hispanic White, and mean [SD] age = 56.1 [9.8] years). Numerically, unadjusted total all-cause HCRU and costs increased with higher BMI classes; this was consistent across years of follow-up. In both the primary and secondary prevention cohorts, total costs among people with obesity ranged from 1.1-fold (class 1, ≥30 to <35 kg/m 2 ) to 1.3-fold (class 3, ≥40 kg/m 2 ) higher than those of people with normal weight after adjustment. CONCLUSIONS: This real-world study highlights the increasing economic impact of obesity in commercially insured people with or at risk of ASCVD. Future research is warranted to examine weight management strategies as an integral part of the primary and secondary prevention of ASCVD.