Monday, March 04, 2013

Bariatric Surgery in Obese Persons Does Not Reduce Long-Term Health Care Costs

One type of drastic treatment for obesity is bariatric surgery (also known as weight-loss surgery).This involves surgically reducing the stomach size, removing a part of the stomach, or removing and re-directing the small intestine to a small stomach pouch. The latter is referred to as gastric bypass surgery. The small intestine is the part of the intestine that takes in all of the nutrients that the body needs.

The surgery is known to help with weight loss and improves overall health. An example is remission of diabetes mellitus. In diabetes mellitus, the body is not able to effectively use a natural chemical called insulin, which quickly absorbs glucose (a type of sugar) from the blood into cells for their energy needs and into the fat and liver cells for storage.

While bariatric surgery has health benefits, it is also associated with frequent complications such as bloating and diarrhea after eating, infections, leaks at the surgical site, hernia (tissue protrusion) through the incision site, and pneumonia. Pneumonia is inflammation of the lungs due to infection.

With health care reform a reality, an increasing focus of insurers will be if the surgery actually reduces long-term health care costs. The surgery is currently approved by insurance companies due to the potential to improve health care costs.

In an upcoming article in JAMA: Surgery, researchers published a study designed to analyze the long-term health care costs associated with bariatric surgery. The study followed-up 29,820 patients who underwent bariatric surgery between 2002 and 2008 under a BlueCross Blue Shield insurance plan across the U.S, making it the largest study of its kind.  The patients were compared to a matched control group that did not undergo surgery but who had obesity or diagnoses closely associated with obesity (e.g., diabetes mellitus).

Results of the study showed that total healthcare costs were greater in the bariatric surgery group during the second and third years after surgery but were similar in the later years. In specific areas, the bariatric group had higher inpatient care costs which offset lower costs for prescriptions and office visits. The authors concluded that bariatric surgery does not reduce overall health care costs in the long-term and that there was no evidence that one type of bariatric surgery was more likely to reduce long-term health care costs.

In an accompanying article in the journal, Dr. Edward Livingston (Deputy editor of JAMA) noted that bariatric surgery should only be offered to highly selected patients: those in whom there is an overwhelming probability of long-term success, who have complications of obesity that can improve with weight loss surgery, and who have history of demonstrated medical and dietary compliance.

Suggested Reading: The Obesity Epidemic: What Caused It? How Can We Stop It?
References: Livingston EH. (2013, in press). Is Bariatric Surgery Worth It?: Comment on "Impact of Bariatric Surgery on Health Care Costs of Obese Persons". JAMA: Surgery.

Weiner JP, Goodwin SM, Chang HY, Bolen SD, Richards TM, Johns RA, Momin SR, Clark JM. (2013, in press). Impact of Bariatric Surgery on Health Care Costs of Obese Persons: A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data. JAMA Surgery.

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