Utility Decrements Associated with Adult Overweight and Obesity in Australia: A Systematic Review and Meta-Analysis

Objective: The aim was to conduct a systematic review and meta-analysis of health state utility decrements associated with overweight and obesity in adults 18 years and over, for use in modelled economic evaluations in Australia. Methods: A systematic review was conducted in nine databases to identify studies that reported health state utility values by weight status. Random-effects meta-analysis was used to synthesise average utility decrements (from healthy weight) associated with overweight, all obesity and obesity classes 1, 2 and 3. Heterogeneity surrounding utility decrements was assessed via sub-group analysis, random-effects meta-regression and sensitivity analyses. Results: Twelve studies were found for which data were used to synthesise utility decrements, estimated as overweight = 0.020 (95% confidence interval 0.010–0.030), all obesity = 0.055 (0.034–0.076), obesity class 1 = 0.047 (0.017–0.077), class 2 = 0.072 (0.028–0.116) and class 3 = 0.084 (0.039–0.130). There was considerable heterogeneity in our results, which could be accounted for by the different ages and utility instruments used in the contributing studies. Conclusions: Our results demonstrate that elevated weight status is associated with small but statistically significant reductions in utility compared with healthy weight, which will result in reduced quality-adjusted life years when extrapolated across time and used in economic evaluations.