Objective: The objective of this study is to estimate direct medical costs attributable to obesity in Kazakhstan from the government perspective for and 2030. Method: Cost-of-disease-incidence-based approach was used to estimate the direct medical costs, including hospital care, drugs . , physician and nursing care covered by the government. There are three types of data required for this study, including the actual and predicted estimates of obesity prevalence in Kazakhstan for and 2030, relative risks for IHD, stroke and T2D and costs for specific disease treatment.
Thus, the main formula involves multiplying the proportion attributable to the population by the cost of treating the disease. Thus, compared to 2008 cost estimates, direct medical costs borne by the government in Kazakhstan will double for IBD and stroke and ⅓ for T2D complications by 2030. Discussion and conclusion: Costs associated with IBD, stroke stroke and complications of T2D attributable to obesity in Kazakhstan will reach KZT by 2020, which represents 11.3% of the money allocated for 2019 of the government health care development program "Densaulyk" for 2016-2019.
Taking into account that no adjustments were made for future currency fluctuations, medical services and drug costs, future direct medical costs could be significantly higher than estimated in the study. It should be mentioned that significant amounts of money can be saved in the future if the government takes the required measures.
Definition of Obesity
Overweight and obesity have been defined as a body condition with extra body fat and thus body weight that can negatively affect the individual's health. Major sources determine overweight and obesity using a body mass index (BMI) equal to or greater than 25 and 30, respectively. BMI is calculated by dividing weight in kilograms by the square of height in meters (kg/m2) (WHO, 2018).
It should be noted, however, that there are alternative measures of overweight and obesity, including waist circumference, waist-to-height ratio, waist-to-hip ratio, and body fat mass. One of the reasons for replacing BMI with other measures is that some ethnic groups have different body types as well as different perceptions of normal body proportions. Specifically, Asian people were found to have an increased risk of mortality at BMI greater than 25 compared to the American population.
In addition, the Asian population tends to have a central obesity which is an important factor for the development of cardiovascular and metabolic disorders (Lear et al., 2007). Since BMI has been commonly used in studies related to overweight and obesity, it was also used in this research.
Trends of Obesity in Kazakhstan
8 Georgia, the Kyrgyz Republic, Tajikistan, Turkmenistan and Uzbekistan were the leaders in the absolute number of obese people from 1990 to 2013. Moreover, the percentage of change in the prevalence of obesity in Kazakhstan (about 16.6 %) was more than the average for Central Asia (about 16.4 %) (Helbe and Francisco, 2017). Studies conducted by the Kazakh Academy of Nutrition in 2014 revealed that 55.5% of women, 49.2% of men, and 14.7% of children suffer from overweight or obesity in Kazakhstan (Kazakh Academy of Nutrition, n.d.).
Data provided by WHO (2017) also show a steady increase in the prevalence of overweight and obesity in Kazakhstan from 1975 to 2016 among the adult population. These projected estimates underscore the importance of introducing programs to reduce the prevalence of overweight and obesity among the population of Kazakhstan.
Diseases associated with Obesity in Kazakhstan
It was estimated that approximately 3.6% of cancer deaths in adults in 2012 were associated with an increase in BMI. An increase in the number of urban population, an increase in the life expectancy of the Kazakhstani population and an increase in the population's incomes in the next decade will lead to a rapid increase in the number of patients suffering from type II diabetes. It was estimated that in 70-80% of diabetes cases, patients died due to cardiovascular diseases caused by diabetes (A.Zh. Ilmalieva et al., 2016).
10 Diseases associated with obesity, including cardiovascular disease, cancer and diabetes in Kazakhstan, thus significantly affect morbidity and mortality among the population. In addition, medical treatment of these ailments is mostly covered by the government through the special medical service package called "Guaranteed package of free medical care" (Resolution of the Government of the Republic of Kazakhstan dated January 27, 2014 No. 29). As the prevalence of cardiovascular diseases, cancers and diabetes is steadily increasing in Kazakhstan, an increase in the costs of them is expected.
As obesity has been found to be one of the main causes of these conditions, there is an opportunity to reduce morbidity by preventing the spread of obesity. In this study, only three specific diseases were selected for cost estimation, namely ischemic heart disease, stroke, and complications of type II diabetes.
METHODS AND MATERIALS
The main reason is the lack of detailed data on the prevalence of obesity-related diseases and their costs covered by the government. This approach also needs less data and fewer assumptions compared to incidence-based studies. Only data related to one year are required, ignoring survival rate and disease course.
The main assumption required for this method is that the structure of costs and discounting will not change in the future (Segel, 2006). Since this approach includes the annual medical costs, it is more advantageous method for chronic diseases. Therefore, the cost-of-illness-prevalence-based approach has been chosen for this particular study (Henriksson et al,. 2000).
Estimating the Direct Costs of Obesity
- Calculating PAFs for T2D, IHD and stroke
- Calculating medical direct costs for T2D, IHD and stroke
Since PAF has shown an increasing rate over the years offered, it is expected that there will be an increase in the pace of costs.
Discussion of the results
Strengths and limitations
Although there is extensive knowledge about the prevalence, determinants and consequences of obesity, there are no officially published articles on this topic in Kazakhstan. Thus, this research reveals the first estimates of obesity-related costs in Kazakhstan and provides valuable information for further potential cost-effectiveness and cost-benefit analyzes (Segel, 2006). Another advantage is that the results of this research could be used to assess the risk of obesity prevalence in Kazakhstan and draw the government's attention to adult overweight and obesity and the financial implications associated with this issue.
One of the limitations to be mentioned is the lack of detailed costs for outpatient and inpatient services, drug costs, rehabilitation, nursing care and other expenses per patient in Kazakhstan. 19 This study could be expanded to different types of cancer, cardiovascular disease, and other obesity-associated conditions.
Metabolically healthy obesity and risk of incident type 2 diabetes: a meta-analysis of prospective cohort studies. Retrieved from https://www.worldobesity.org/what-we-do/policy-prevention/projects/eu-projects/dynamohiaproject/estimatesrelativerisk/. Incidence of comorbidities associated with obesity and overweight: a systematic review and meta-analysis.
Brochure produced by order of the Ministry of Education and Science of the Republic of Kazakhstan. Retrieved from the official site of the Republic Medical University http://med-obuch.kz/mozgovoy-insult-principy-diagnosti/. 2136 of the Government of the Republic of Kazakhstan from December on approval of the list of guaranteed free medical assistance".
Report of the President of the Diabetes Association of the Republic of Kazakhstan (DARK) Tukalevskaya N.N. Retrieved from http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/country-work/kazakhstan. Illness costs for one treated case established by order of the Ministry of Health Care for 2013 (KZT).
Coefficient mean risk of T2D-specific complications and derived from Gan, D. Coefficient mean risk of T2D-specific complications and derived from Gan, D.