No Reduction of Costs After Gastric Bypass?

A new study of older male patients says that gastric bypass may not result in healthcare savings for this group. Researchers at the Center for Health Services Research in Primary Care found that healthcare costs for gastric bypass patients involved in this study, remained about the same following surgery.  The study compared 850 military veterans who received bariatric surgery with a similar number of veterans who did not receive surgery.  They studied their medical costs in the three years prior to surgery and three years post-surgery. The researchers found that in the years prior to surgery, hospital inpatient and outpatient costs for people who had bariatric surgery were about $600 lower than for those who didn’t have the procedure. In the six months before surgery, however, the costs were $28,400 higher (including the operation). In the six months after surgery, costs were almost $4,400 higher but then declined to about the same level as before surgery. “While there were significant health benefits that were realized in these patients, they just didn’t translate into cost savings over three years”, said the lead researcher, Matthew Maciejewski. He added that the findings may only apply to this particular group of mostly male patients, who were both older and sicker than other patients who have bariatric surgery. In other groups, the procedure may reduce healthcare spending.

Last year, we covered a study that found that bariatric surgery is a cost-effective treatment for mildly to severely obese individuals. The study used a metric called the quality-adjusted life year (QALY), which measures the value of treatment in terms of one’s quality and length of life. In the United States, in order for a medical treatment to be considered cost effective, the limit is $50,000 – meaning that is assumed that a person would be willing to pay up to $50,000 for an additional year of a healthy life. Any cost less than the $50,000 is said to be cost-effective.  Using this method, the researchers from Washington University School of Medicine in St. Louis found that for those with a BMI of 50 or greater, the cost per QALY was negative, meaning that the cost of weight loss surgery is less than the medical costs associated with not having the surgery. For patients with a BMI of 40-50, the cost per QALY was about $3,800 which is well below the limit of $50,000. Lastly, for the moderately obese (BMI of 35-40), the cost per QALY was about $3,900, again well below $50,000.

Other studies have also found that obese people who have weight loss surgery improve their health and reduce the cost of their care. Dr. Jaime Ponce, President of the American Society for Metabolic and Bariatric Surgery (ASMBS) and bariatric surgeon in Chattanooga  told us there is documented evidence that bariatric surgery is a cost effective treatment for morbid obesity and its associated co-morbidities. “An analysis of a private payer database showed that cost savings associated with bariatric surgery began accruing as early as 3 months after surgery although downstream savings were estimated to offset the initial costs in 2 to 4 years,” he told us, citing a study titled “Study on the Economic Impact of Bariatric Surgery”, published in the American Journal of Managed CareDr. Christine Ren-Fielding, chief of bariatric surgery at NYU Langone Medical Center was interviewed by Reuter’s about this recent study. She explained that “differences between patients may also help explain the findings.  For example, if people who chose to get bariatric surgery were somehow sicker to begin with, doctors would expect them to need more costly care in the coming years.” Dr. Ren Fielding added that perhaps earlier intervention would make a difference in financial outcomes.

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