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Study calls for increase in publicly-funded surgery

No significant difference in weight loss between sleeve vs banding patients at 3, 12 and 24 months

The Australian government should increase access to publicly funded lap-band surgery for obese patients to reduce the health inequities for those most in need, according to research titled, ‘The efficacy of bariatric surgery performed in the public sector for obese patients with comorbid conditions’, published in the Medical Journal of Australia.

A team led by Associate Professor Tania Markovic from Royal Prince Alfred Hospital, Sydney, analysed data from obese patients who underwent publicly-funded bariatric surgery between October 2009 and September 2013. They measured postoperative weight loss, and markers to assess improvement of type 2 diabetes, hypertension and obstructive sleep apnoea.

“Limited access to surgery discriminates against those who cannot afford the out-of-pocket costs, yet it is likely that this subgroup would benefit most…"

Sixty-five patients (41 women and 24 men) with a mean age of 51.5 years and a mean of eight comorbid conditions per patient and class III (severe) obesity. From baseline to 18 months, three participants were lost to follow-up. The most commonly performed procedure was LSG (57 patients vs. 8 patients who had LAGB.

Outcomes

Sixty-five patients lost a mean of 17% of their preoperative weight by three months post-surgery, 26% by 12 months and 29% by 24 months. Although there was more weight loss reported in the LSG group, the difference was not significant at three months (p=0.58), 12 months (p=0.25) or 24 months (p=0.17).

The authors reported BMI decreased from a mean of 48.2 pre-surgery to 35.7 at 24 months. By 12 months, there was full resolution of diabetes in 50% of patients, hypertension in 55% and sleep apnoea in 63%, with further improvements at 24 months.

Costs

The direct public sector operative costs of performing the surgeries were estimated to be $7,000–$9,000. In addition, they examined perioperative costs, including two years of postsurgical visits, taking the total cost to $9,000–$11 ,000 per patient.

“A 2005 paper reported the annual cost of managing an individual with T2DM as $9,095–$15,850.25,” the authors write. “Thus, if an obese person with T2DM has bariatric surgery, the operation would pay for itself after about one year.”

“Strategies to prioritise access are therefore recommended to reduce the apparent inequality that exists,” the authors conclude. “Limited access to surgery discriminates against those who cannot afford the out-of-pocket costs, yet it is likely that this subgroup would benefit most…we hope that our study provides an evidence base for the surgical treatment of obesity in the public health system and, in turn, that consideration will be given to increasing the supply of publicly funded bariatric surgery in Australia.”

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