Bariatric surgery demonstrates cost recovery in less than 2 years: Study

A recent study confirms cost recovery and long-term savings for morbidly obese patients undergoing bariatric surgery procedures.

Results from the non-randomized, case-controlled study published online in PLOS ONE found that for morbidly obese patients (Body Mass Index >40) undergoing laparoscopic adjustable gastric banding (LAGB or banding) and laparoscopic roux-en-y gastric bypass (LRYGB or bypass) procedures “confirms the important health economic benefits of bariatric surgery,” according to study author John Dixon, PhD, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.

“Rarely does any surgical intervention provide a health sector return on healthcare expenditure,” Dixon said. “The important novel aspect of this study was the incorporation of 2 propensity match control groups, one with a diagnostic code of morbid obesity and a more conservative matching to those without this code. There has been some doubt about using those with a morbid obesity classification due to possibility rapidly increasing costs and this may lead to an optimistic economic view of surgery.”

Dixon and colleagues examined claims data from the MarketScan Commercial Claims and Encounters database between January 2003 and September 31, 2009. Patients who had either LAGB and LRYGB surgery were propensity score matched to one another and to 2 control groups: One restricted to those with a morbidly obese diagnosis code and one without this restriction. Propensity matched quarterly claim costs before and after the quarter with surgery or pseudo-surgery the key outcome measure was a comparison of costs following the intervention quarter. All 4 propensity matched groups were then compared for their prospective costs. While patients (n=120,000) in both surgery groups realized a cost benefit, those who opted for the banding procedure recovered costs sooner than those who underwent the bypass procedure. Medical cost savings at 5 years for banding patients was $78,980 and $61,420 for bypass patients.

Unlike previous data on this topic, this study not only included morbidly obese patients as identified by the International Statistical Classification of Diseases and Related Health Problems 9^th Edition (ICD-9) code, but also included patients who were not restricted to the morbid obesity diagnosis code and had a BMI of 35 to less than 40 with at least 1 obesity-related comorbidity (such as diabetes, hypertension and/or dyslipidemia). In this subset of patients, the time to breakeven for both procedures increased with banding patients recovering costs within 5.25 years and bypass patients seeing a cost recovery beyond 10 years. Net costs at 5 years for this subset were $690 for banding patients and $18,940 for bypass patients.

“These data are critical as it provides insights into the value of surgical interventions for those with severe complex obesity,” Dixon said. “Providing surgery, especially LAGB surgery, provides a return on investment along with the known benefits of weight loss following surgery: Improvements in quality of life, physical function, and overall health, as well as reduced premature mortality. There are the additional broader economic productivity benefits of improved work participation, presenteeism, and reduced absenteeism. There are therefore great benefits to the heath sector, the individual, and the broader economy.

“The economic arguments for this therapy are compelling yet the are barriers for eligible patients are significant,” Dixon concluded. “We need overcome the community bias against severe obesity and its therapy.”

Disclosures: The study was funded by Allergan, Inc. Mr Dixon is a consultant for Allergan.