Bariatric surgery reduces national health care costs

Issue: December 2015

LOS ANGELES — Bariatric surgery provides a substantial return on investment in the long run, particularly for patients with diabetes, according to research presented at ObesityWeek.

“The economic burden of obesity is truly a dose-dependent effect — as your BMI goes up, your cost goes up,” John M. Morton, MD, of Stanford University School of Medicine, said. “In the United States, what we’re spending on obesity is roughly 20 cents on the health care dollar, and that’s probably an underestimate, given the fact that obesity affects other diseases like cardiac and joint disease.”

John M. Morton

Morton and colleagues analyzed claims data from the Truven Health Analytics (MarketScan) commercial claims database from 700 patients with obesity (aged 18 to 64 years in 2009 to 2013; 78% women) who underwent Roux-en-Y gastric bypass surgery in 2009, and 670,214 patients who did not have surgery and who were matched for age, sex, geographic region and comorbidities, including diabetes, hypertension, hyperlipidemia; 4,875 additional patients were matched for morbid obesity. All participants were continuously enrolled in the health plan for 4 years before and 4 years after surgery. Matches had not undergone bariatric surgery from 2005 to 2008, and those with cancer or other diagnoses incompatible with bariatric surgery were excluded.

Costs associated with surgery were calculated according to a “payor perspective” and did not include other considerations, such as quality of life or productivity costs; however, researchers included lost work calculations in which 1 day of hospital readmission or clinic visit counted as 1 day of lost work.

Mean costs for the surgery patients totaled $25,238. For the 4 years after surgery, researchers compared actual health care costs incurred by the surgery group with expected costs modeled on the nonsurgery group. Costs in the surgery group leveled off after the procedure, whereas costs in the nonsurgery group continued to rise year after year.

In the first year after surgery, actual costs were 12% lower than expected costs — $9,529 compared with $10,651 — and continued to decrease in the following years (by 28%, 37% and 35%, respectively). Overall, about 38% ($7,592) of the costs of surgery were recouped in the following 4 years.

The savings for surgical patients with diabetes, who made up 30% of the cohort, were even greater — about 78% ($22,609) overall, including actual costs reduced by 23%, 49%, 61% and 69% in the 4 years, respectively.

In the 4 years after 2009, the hospital admission rate and lost work time for the surgery group were significantly lower than that for the nonsurgery cohort.

“On the basis of their medical costs, the offset [of costs of bariatric surgery] occurs sooner when patients are diabetic, but we can also see there are advantages for all those patients undergoing bariatric surgery, particularly lower readmission rates afterward and lower lost work time as well,” Morton said. – by Jill Rollet

Reference:

Morton J, et al. Abstract A106. Presented at: ObesityWeek; Nov. 2-6, 2015; Los Angeles.

Disclosure: Morton reports relationships with Apollo Endosurgery and Olympus.