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Surgical costs

Overall health costs are not reduced by bariatric surgery

No evidence that the type of surgery affects overall cost
Future studies should focus on the potential benefit of improved health and well-being of patients undergoing the procedure rather than on cost savings

Researchers from the Johns Hopkins Bloomberg School of Public Health and School of Medicine have concluded that bariatric surgery does not reduce overall health care costs in the long term, compared to non-surgical patients. The study, “Impact of Bariatric Surgery on Health Care Costs of Obese Persons”, published in the journal JAMA Surgery is the largest and longest duration of its type to date.

“The results of our study are important because they demonstrate bariatric surgery does not lower overall health care costs in the long term and we found is no evidence that any one type of surgery is more likely to reduce long-term health care costs," said lead author of the study, Dr Jonathan Weiner, professor of health policy and management, Bloomberg School.

Bariatricnews.net has previously reported that patients who have bariatric surgery use fewer medications to treat diabetes and cardiovascular disease resulting in lower overall drug costs. Two further studies highlighted how the therapeutic benefits of bariatric surgery on diabetes can translate into considerable economic benefits.

Despite the study’s conclusions, Weiner does admit that this study was not a cost/benefit analysis and therefore, it is limited in its applicability to the wider cost-effective debate regarding surgery.

 

Dr Jonathan Weiner

"This simply looked at cost. We did not look at benefit. This would only be one-half of the value equation,” Weiner told Reuters News. “If I were an insurer, I would never use just this study. I would look at longevity, improved health, and of course satisfaction."

Study

Weiner and colleagues analysed claims data from 29,820 Blue Cross/Blue Shield plan members from across the US who underwent bariatric surgery between January 2002 and December 2008, and matched them on a one-to-one basis with a comparison group who did not undergo surgery. Controls were also matched to the surgery patients for age, sex, obesity-related conditions, including hypertension, type 2 diabetes, sleep apnoea, metabolic syndrome, and/or gallbladder disease.

The two groups were closely followed over a seven year period and the researchers measured the overall costs and type of care cost costs of both groups.

Results

The results revealed that the surgery group had higher up-front cost of care, including the cost of the surgery itself plus the 30-day postoperative care, with the average procedure approximately $29,517.

In each of the six years following surgery, health care costs were either the same or slightly higher in the bariatric surgery group, with the average annual claims ranging between $8,700 and $9,900 per patient.

The annual total costs peaked the year following surgery and then plateaued, but remained above that of the pre-surgery period for the entire six-year follow-up. After adjustment, total expenditures for the surgery patients were 16% higher than the non-surgery patients in second year after surgery and 7% higher in the third. The costs for the two groups were roughly comparable in the remaining years.

The study reports that there were notable differences in the types of costs incurred. After adjustment, inpatient costs were significantly higher for the surgery patients, while pharmacy and physician-office costs were significantly lower compared with the non-surgery patients. The medication cost-savings in the surgery group were cancelled out by the costs associated to weight loss surgery.

An analysis of type of the surgery showed that total costs for laparoscopic gastric bypass and for laparoscopic banding were significantly lower than for open gastric bypass during years the first two years, due to lower inpatient costs. However, there was less follow-up time for laparoscopic procedures.

The inclusion of open procedures was a limitation of the study, as the vast majority of bariatric procedures are now laparoscopic. The inclusion of open procedures would have increased the 30-day postoperative care costs and a previous study has shown that the higher initial operative costs for laparoscopic gastric bypass were offset by the lower hospital costs.

Summary

"Future studies should focus on the potential benefit of improved health and well-being of patients undergoing the procedure rather than on cost savings," said Weiner. “Given the ever increasing rate at which bariatric surgery is being performed, we felt it was important to measure the impact of health care costs associated with this type of surgery."

In an invited critique, JAMA deputy editor, Dr Edward H Livingston, states that the current evidence suggests that there is no economic benefit for weight loss surgery, implying that “the indications for bariatric surgery should be viewed in terms of individual patient benefit without anticipating that there will be cost savings to a health care system by offering this treatment.”

"Current data suggest that weight-loss operations should be offered to highly selected patients," Livingston writes. “Patients considered for bariatric surgery should have a complication of obesity that is known to dramatically improve with weight loss surgery…In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients. Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success."

The study was partially funded by surgical product manufacturers and pharmaceutical companies, including Johnson & Johnson and Pfizer.

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