Health care costs not reduced after bariatric surgery

Feb 21st – Patients who underwent bariatric surgery did not have overall health care costs lower than similarly obese patients who did not undergo surgery.

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Image: PD. Worldwide % Obese (Dark = higher)

1. Patients who underwent bariatric surgery did not have overall health care costs lower than similarly obese patients who did not undergo surgery. 

2. Post-bariatric surgery patients have higher overall costs in years 2 and 3 following surgery. 

3. Office visit costs were lower for bariatric surgery recipients.

This study provides the largest cohort to date of bariatric surgery patients over time and distinguishes among the different types of procedures.  The authors went to considerable length, examining over 30 variables, to cross match the comparison group as much as possible with the surgical group.  The main finding is that there are no total costs savings in health spending after undergoing bariatric surgery.  We agree with the author’s assessment that the focus going forward should mostly entail measuring improvements in mortality and quality of life instead of cost savings.  Those benefits should therefore play the largest role in determining who should undergo bariatric surgery and which procedure they should choose.  The two main limitations of this study are the lack of randomization, and its focus on private health insurance patients under 65. Although not randomized, it is helpful that the authors made a significant effort to match the two groups across as many variables as possible, limiting the chances of confounding.  As for the patient population, this study may not let us extrapolate the results further to patients above 65 or without private insurance since their health issues and spending patterns may be different.

Click to read the study in JAMA Surgery

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Image: PD. Worldwide % Obese (Dark = higher)

1. Patients who underwent bariatric surgery did not have overall health care costs lower than similarly obese patients who did not undergo surgery. 

2. Post-bariatric surgery patients have higher overall costs in years 2 and 3 following surgery. 

3. Office visit costs were lower for bariatric surgery recipients.

This [retrospective cohort] study analyzed insurance claims and pharmacy costs for 29,820 bariatric patients across 7 states. It included patients who had bariatric surgery between 2002 and 2008 and were enrolled in the same insurance plan for at least 6 months post-operatively.  This surgical group was matched 1:1 with patients meeting similar criteria who did not undergo surgery.  Total health care spending costs for surgical patients in years 2 and 3 post-operatively were significantly higher than in non-surgical patients, at 16% and 7%, respectively.  This observation was coupled with the finding that surgical patients incurred higher inpatient costs in exchange for lower office and pharmacy costs.  Except for post-operative year 6, the reductions in office and pharmacy costs among surgical patients were statistically significant.  Inpatient costs were higher for the surgical group all years post-operatively, even after adjusting for all the demographic and clinical variables.  In comparing the different surgical approaches to bariatric surgery, laparoscopic procedures led to significantly lower total costs for only the first 2-3 years.

In sum: This study provides the largest cohort to date of bariatric surgery patients over time and distinguishes among the different types of procedures.  The authors went to considerable length, examining over 30 variables, to cross match the comparison group as much as possible with the surgical group.  The main finding is that there are no total costs savings in health spending after undergoing bariatric surgery.  We agree with the author’s assessment that the focus going forward should mostly entail measuring improvements in mortality and quality of life instead of cost savings.  Those benefits should therefore play the largest role in determining who should undergo bariatric surgery and which procedure they should choose.  The two main limitations of this study are the lack of randomization, and its focus on private health insurance patients under 65. Although not randomized, it is helpful that the authors made a significant effort to match the two groups across as many variables as possible, limiting the chances of confounding.  As for the patient population, this study may not let us extrapolate the results further to patients above 65 or without private insurance since their health issues and spending patterns may be different.

Click to read the study in JAMA Surgery

By David Mattos and Allen Ho

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