VA finds 3 years isn’t enough to reduce health costs following bariatric surgery
■ The organization looked at surgeries performed on older patients compared with previous studies.
The possibility of decreased medical expenditures after bariatric surgery is commonly used to persuade insurers to pay for it, but the procedure may take more time to realize savings in patients who are older and have significant obesity-related medical issues than those who are younger and healthier, according to a study published in the July Archives of Surgery (link).
Researchers compared data on 847 veterans who underwent the procedure at a Dept. of Veterans Affairs medical center and veterans of a similar age and health cohort who did not, but received most of their health care at these facilities for a wide array of ailments. The VA-funded study found there was no statistically significant difference between the medical expenses for the two groups after three years.
After an initial spike in costs postsurgery for bariatric patients, the outpatient expenses of surgical patients 31 to 36 months after the procedure were $40 more than for those who did not undergo the procedure. Meanwhile, inpatient costs for those who had the surgery were $45 higher in that same period compared with those who did not have the procedure.
Previous studies have found the cost of the surgery is recovered in two to five years because various medical expenses are reduced, but these looked at patients in their 30s or early 40s with average BMIs closer to 40. The average age in the VA study was 49, and 47 was the average body mass index. The study calculated presurgical costs, but others did not.
“Bariatric surgery has tremendous health benefits for patients like ours, but it doesn’t appear that the economic benefits are realized three years out,” said Matthew L. Maciejewski, PhD, lead author of the Archives paper and a research career scientist with the Center for Health Services Research in Primary Care at the Durham VA Medical Center in North Carolina. “We may need a longer time frame to realize the economic benefits.” Maciejewski is continuing to follow these patients to determine when cost savings may be realized and which patients may be better candidates for surgery.
Bariatric surgeons say the study suggests the procedure may need to be carried out before obesity-related ailments have wreaked much havoc to achieve its potential. Patients with a BMI greater than 40 generally are considered eligible. Those with BMIs as low as 30 may qualify because of medical issues connected to their weight.
“It’s much better to take care of obesity sooner than later,” said Jaime Ponce, MD, president of the American Society for Metabolic and Bariatric Surgery. “For example, if a patient has diabetes, the longer that you leave things, the more damage there is to the pancreas and the more difficult it is to reverse that diabetes.”
In addition, the study looked at patients who had the procedure from 2000 to 2006. Bariatric surgeons say that, since then, minimally invasive surgeries, which can involve shorter hospitalizations and fewer complications than open procedures, have become more common and may further alter the cost curve.
Ninety-seven percent of the veterans in the study underwent Roux-en-Y gastric bypass. Only 54% of patients having bariatric surgery had this version in 2010, according to the ASMBS. More than 39% had the adjustable gastric band. The remainder had less common procedures such as the sleeve gastrectomy. The more invasive procedure can cost $18,000 to $35,000 in the private sector. The band tends to be less expensive, with figures around $2,500 often quoted.
The number of bariatric surgery procedures has plateaued in recent years because of the economy and difficulties with insurance payment. A total of 16,200 were performed in 1993, and this grew to 220,000 in 2008, according to the ASMBS. The total held at 220,000 in 2009. Numbers for subsequent years are not available. ASMBS surveys indicate about 25% of patients considering the procedure are turned down at least three times by their insurers.