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Comparative costs

Little difference in RYGB vs. banding costs

RYGB was associated with increased emergency department (ED) visits in the two years after surgery

A study comparing the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs, has concluded that both procedures were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by three years post-surgery. Published in JAMA Surgery, the paper notes that RYGB was associated with increased emergency department (ED) visits in the two years after surgery.

The study by researchers at Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Atlanta, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts and the Group Health Research Institute, Seattle, Washington, examined quarterly and yearly total health care costs, ED visits, hospital days and prescription drug costs. They used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year.

Between September 2011 and January 2015 they identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011, and propensity score matched 4,935 AGB to 4,935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, ED visits, and hospital days. Median postoperative follow-up time was 2.5 years.

Outcomes

They found that AGB and RYGB were associated with downward trends in costs; however, by year three, AGB patients had total annual costs that were 16% higher than RYGB patients (p<0.001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years one and two, AGB was associated with 27% to 29% fewer ED visits than RYGB (p<0.001; absolute changes: −0.6; 95% CI, −0.9 to −0.4 and −0.4; 95% CI, −0.6 to −0.1 visits/person, respectively). By the third year, they report that there were no detectable differences.

In addition, postoperative annual hospital days were not significantly different between the groups, although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (p<0.001).

They conclude that although both procedures were associated with flattened total health care cost trajectories the fact RYGB patients experienced lower total and prescription costs by three years post-surgery with is countered by RYGB been associated with increased ED visits in the two years after surgery. Therefore, the researchers state that clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.

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