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Medication reduction, cost savings seen after bariatric surgery
Patients with obesity who underwent bariatric surgery significantly reduced their medication use and saved on drug costs compared with those who did not have the surgery, according to research presented at Obesity Week 2014.
“Pharmacy costs ended up being about 20% lower overall for those patients who had surgery,” John M. Morton, MD, of Stanford University School of Medicine, told Endocrine Today. “We saw profound differences for patients taking diabetes, blood pressure and cardiac medications.”
John M. Morton
Morton and colleagues from other institutions analyzed records from the commercial Truven Health MarketScan databases, incorporating all 50 states and containing claims data from multiple health insurers for approximately 70 million enrollees in the United States, between 2007 and 2012.
“These are national data, which is a bit different from past studies with several states, or one state or one hospital, and long-term results,” Morton said.
The researchers identified adult patients with procedure codes for laparoscopic gastric banding and bypass bariatric surgery (surgical group) in 2008 and propensity-matched patients with obesity (nonsurgical group; BMI >40 kg/m2, BMI >35 kg/m2 with obesity-related comorbidity or specific procedure code and obesity-related comorbidity but no evidence of bariatric surgery).
Health care claims for both groups (n=2,700 for each, based on capture algorithm) were analyzed longitudinally during a 4-year postoperative period. Patients all had more than 6 years of continuous eligibility, and those with cancer diagnosis were excluded. Student’s t test, chi-square and multivariate linear regression were used for comparisons.
Four years after surgery, patients who underwent bariatric surgery had 22.4% lower pharmacy costs (RR=0.776; 95% CI, 0.732-0.822) vs. nonsurgical controls, accounting for preoperative costs and patient characteristics.
In the year preceding surgery, the surgery group had $3,098 and the control group $2,303 in overall pharmacy costs; however, a reversal was seen at 1 year after surgery, with $2,209 and $2,407, respectively, in overall pharmacy costs.
At 4 years, a sustained decrease in medication costs was seen in the surgery group vs. the control group, with $8,411 and $9,900 consumed, respectively, in overall pharmacy costs.
Medication use among patients in the surgery group declined from 1-year preoperative to 4 years postoperative (diabetic, –13.3%; hypertension, –6.9 %; cardiac, –1.3%) compared with a rise in usage among patients in the control group (diabetic, 7.6%; hypertension, 10.9%; cardiac 12.4%).
The number of antidiabetic medications used by patients who underwent surgery dropped 73.7% (RR=0.2627; 95% CI, 0.2560-0.2696) in the 4-year postoperative period compared with those who did not have surgery. Antihypertensive medication use decreased 46.8% (RR=0.5311; 95% CI, 0.5233-0.5391) and cardiac medication use 47% (RR=0.53; 95% CI, 0.5178-0.5424).
“When we started the study, patients who didn’t have surgery were spending on average $358 on diabetes medications, and 4 years later it was $1,669, or a fourfold increase,” Morton said. “Compared with patients who had surgery, that’s a pretty big difference.” – by Allegra Tiver
For more information:
Morton JM. Abstract A103. Presented at: Obesity Week; Nov. 2-7, 2014; Boston.
Disclosure: Morton reports being a consultant for Covidien and Ethicon, a board/committee member for Vivus and receiving honorarium from all three.
Perspective
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In the current-day environment of value-based treatments, such cost data are very important to convince payors to continue reimbursing bariatric surgery and in fact expanding coverage. We all see a decline in number of medications and types of medication after bariatric surgery. It is also important to see this observation quantified in term of cost savings.