Mendelian randomization: estimation of inpatient hospital costs attributable to obesity

Health Economics Review

John E. Schneider¹  Katherine Dick¹  Andrew Briggs²  Stephane A. Regnier³  Pascal Lecomte³  Michael Lean⁴ 

[1] Avalon Health Economics, 26 Washington St. 2nd Floor, 07960, Morristown, NJ, USA;Avalon Health Economics, 26 Washington St. 2nd Floor, 07960, Morristown, NJ, USA;London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, WC1E 7HT, London, UK;Novartis AG, WSJ - 210.15.30.23, CH-4056, Basel, Switzerland;University of Glasgow, University Avenue, G12 8QQ, Glasgow, Scotland;

关键词: Mendelian randomization;    Obesity;    Instrumental variables;    Genetics;    Economics;    Healthcare utilization;   

DOI  :  10.1186/s13561-021-00314-2

来源: Springer

【 摘 要 】

BackgroundMendelian Randomization is a type of instrumental variable (IV) analysis that uses inherited genetic variants as instruments to estimate causal effects attributable to genetic factors. This study aims to estimate the impact of obesity on annual inpatient healthcare costs in the UK using linked data from the UK Biobank and Hospital Episode Statistics (HES).MethodsUK Biobank data for 482,127 subjects was linked with HES inpatient admission records, and costs were assigned to episodes of care. A two-stage least squares (TSLS) IV model and a TSLS two-part cost model were compared to a naïve regression of inpatient healthcare costs on body mass index (BMI).ResultsThe naïve analysis of annual cost on continuous BMI predicted an annual cost of £21.61 [95% CI £20.33 – £22.89] greater cost per unit increase in BMI. The TSLS IV model predicted an annual cost of £14.36 [95% CI £0.31 – £28.42] greater cost per unit increase in BMI. Modelled with a binary obesity variable, the naïve analysis predicted that obese subjects incurred £205.53 [95% CI £191.45 – £219.60] greater costs than non-obese subjects. The TSLS model predicted a cost £201.58 [95% CI £4.32 – £398.84] greater for obese subjects compared to non-obese subjects.ConclusionsThe IV models provide evidence for a causal relationship between obesity and higher inpatient healthcare costs. Compared to the naïve models, the binary IV model found a slightly smaller marginal effect of obesity, and the continuous IV model found a slightly smaller marginal effect of a single unit increase in BMI.

【 授权许可】

CC BY