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Value for money

Study puts brakes on surgical cost recoup claims

Gastric bypass surgery may not be quite as fast to recoup its costs as expected. Photo: AMagill
Medical costs for surgical obese patients drop below costs for non-surgical obese after four years
Total costs still higher for surgical patients six years after surgery
Study results "inconsistent" with earlier findings

A new study has challenged the conventional view on bariatric surgery’s value for money, suggesting it may not be as quick in recouping its costs as previously thought.

The study, published in the Southern Medical Journal, says that while patients in the study began to recoup the costs of their operation four years after bariatric surgery due to a decrease in other obesity-related medical costs, the results were “inconsistent” with the rapid return on investment found in other studies.

“Our study suggests that a long-term return on investment and future cost savings may not occur in all populations and is not likely to be obtained as rapidly as some studies have suggested,” write the authors.

Study

The study investigated the medical and pharmaceutical costs for 39 individuals covered by the Louisiana Office of Group Benefits, the state’s managed health insurance program, for two years before a laparoscopic Roux-en-Y gastric bypass operation, and for four years afterwards.

Medical costs included in the study included all office visits, emergency department, laboratory/pathology, physical and occupational therapy, sleep facilities, and other miscellaneous costs. Pharmacy costs included antidiabetic agents, antihypertensive agents, dyslipidemic agents, psychotherapeutic agents, and "remaining classifications," which included pharmacy costs not included in other subcategories.

The total cost of weight loss surgery was $25,000 per procedure. While medical costs were identical for the two years before the procedure and the three years after the procedure, they began to drop off, in comparison to a control group of obese individuals who did not have bariatric surgery, at year four. 

Medical costs for the control group remained reasonably steady at around $7,500 per year, but in years four, five and six post-surgery, the surgical group’s costs dropped to a significantly lower level than the control group, at $4,507, $4,242, and $2,041.

Overall pharmaceutical costs dropped more quickly than medical costs, demonstrating a significantly lower cost in the surgical group in years two and three after surgery; the cost was lower, but not significantly so, in the remaining years. Costs for antidiabetic agents, antihypertensive agents, and dylipidemic agents were significantly lower in the surgical group at post-surgical year one, remaining so for the duration of the study.

The total combined pharmaceutical and medical costs for individuals in the non-surgical group over the eight-year study period were $73,212. This was lower than the surgical group, whose costs, including the price of surgery, were $77,894 over the same period.

Inconsistency

While the costs in the surgical group were lower four years after surgery, and suggested that the operation may be an overall cost saver within six-eight years, the overall return on investment was slower than that in a commonly-cited study by Cremieux, Buchwald, Shikora, et al, which estimated that savings associated with bariatric surgery would recoup the initial cost within two-four years.

The authors speculate that the discrepancy between the studies could be due to a difference in cost cited for surgery, which was pegged at $17,000 in the prior study, compared to $25,000 in the new study.

The new study also uses actual medical costs for the entire length of the study; the Cremieux study used estimated costs starting 18 months after surgery. However, the authors admit, the new study uses a smaller sample size, which could lead to less reliable results.

While the study replicates results found in previous studies showing a rapid decrease in pharmacy expenditure in the first few years after surgery, the longer study period showed that the savings were not maintained over a longer period.

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