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Publicly funded RYGB higher for first three years, but equal with non-surgical interventions thereafter

Mon, 07/27/2020 - 17:42
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Publicly funded Roux-en-Y gastric bypass (RYGB) appeared to be higher in the first three years but similar thereafter to the costs of non-surgical interventions, according to the paper, ‘Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada’, published in JAMA Surgery. The study found that hospital and emergency department (ED) readmissions after surgical bariatric interventions were associated with increased health care expenditures.

This population-based cohort study in Ontario, Canada, sought to assess the five-year incremental health care use and expenditures after RYGB and compared health care use and expenditures between patients who underwent a publicly-funded RYGB from March 2010 to March  2013, and propensity score–matched control individuals who did not undergo a bariatric procedure.

The final study sample After propensity score matching) included 1,587 RYGB patients and 1,587 individuals in the control group: The mean (SD) age, men BMI and T2DM rates were 47 (10.2) years in the RYGB and 47 (12.2) years for the control cohort, mean BMI was 46, approximately one-third of individuals had diabetes 545 (34.3%) for the RYGB group and 501 (31.6%) for the control group, and both groups comprised 1,228 women (77.4%) and 359 men (22.6%).

The authors reported that approximately 97% of the study population had 60 months of follow-up data. The mean (SD) total health care expenditures in the five-year period before the index date were not statistically significantly different between the groups (p=0.56), CAD$15,594 per individual for the RYGB group and CAD$16 109 per individual for the control group. Mortality at five years was 1.6% (n=25) for the RYGB group and 2.8% (n=44) for the non-surgical group (p=0.02).

The authors reported a sharp increase in the mean number of hospitalisations (from 0.01 to 0.10), ED visits (from 0.13 to 0.43), specialist visits (from 5.22 to 6.51) and total spending (from CAD $1,667 to CAD $9,207) in the three months before and after an RYGB.

Largely associated with the increase in hospitalisations in the first months after the surgical procedure, the mean total health care expenditures per patient in the RYGB group increased from CAD$15,594 in the five-year period before the procedure to CAD$30,389 over the five-year period after (difference of CAD$14,795). This compares with the mean total health care expenditures per individual increased from CAD$16,109 five years before the index date to CAD$20, five years afterward, for a difference of CAD$3,964 in the non-surgical group.

Total health care expenditures decreased for the RYGB group and increased slightly for the control group, levelling off in year three after the index date. The differences in mean (SD) total health care expenditures between the RYGB and control cohorts were not statistically significantly different in year four (CAD$4,188 vs CAD$4,017; p=0.35) and in year five (CAD$4,100 vs CAD$4,023; p=0.79) after the index date.

“This population-based cohort study in Ontario, Canada, found that the costs of publicly funded RYGB appeared to be higher in the first 3 years but similar thereafter to the costs of nonsurgical bariatric interventions,” the paper concluded. “In parallel, mortality decreased in the RYGB group, highlighting some of the societal implications of surgical bariatric procedures. Results of this study suggest the need for strategies to decrease hospital and ED readmissions after surgical bariatric interventions because such use is associated with increased health care expenditures.”

The authors of this study were from McMaster University and St Joseph’s Healthcare Hamilton, Hamilton, University of Calgary, Calgary, Alberta, ICES, the Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.

To access this paper, please click here