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Mendelian randomization: estimation of inpatient hospital costs attributable to obesity

Author

Listed:
  • Katherine Dick

    (Avalon Health Economics)

  • John E. Schneider

    (Avalon Health Economics)

  • Andrew Briggs

    (Avalon Health Economics
    London School of Hygiene and Tropical Medicine)

  • Pascal Lecomte

    (Novartis AG)

  • Stephane A. Regnier

    (Novartis AG)

  • Michael Lean

    (University of Glasgow)

Abstract

Background Mendelian 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). Methods UK 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). Results The 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. Conclusions The 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.

Suggested Citation

  • Katherine Dick & John E. Schneider & Andrew Briggs & Pascal Lecomte & Stephane A. Regnier & Michael Lean, 2021. "Mendelian randomization: estimation of inpatient hospital costs attributable to obesity," Health Economics Review, Springer, vol. 11(1), pages 1-12, December.
  • Handle: RePEc:spr:hecrev:v:11:y:2021:i:1:d:10.1186_s13561-021-00314-2
    DOI: 10.1186/s13561-021-00314-2
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    References listed on IDEAS

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    1. Katja Grašič & Anne Mason & Andrew Street, 2015. "Paying for the quantity and quality of hospital care: the foundations and evolution of payment policy in England," Health Economics Review, Springer, vol. 5(1), pages 1-10, December.
    2. Gitanjali M Singh & Goodarz Danaei & Farshad Farzadfar & Gretchen A Stevens & Mark Woodward & David Wormser & Stephen Kaptoge & Gary Whitlock & Qing Qiao & Sarah Lewington & Emanuele Di Angelantonio &, 2013. "The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis," PLOS ONE, Public Library of Science, vol. 8(7), pages 1-10, July.
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