Counting the cost of bariatric surgery

By Eleanor McDermid, Senior medwireNews Reporter

Bariatric surgery for obese patients is not cost-saving relative to medical care, shows a 6-year follow-up study in JAMA Surgery.

"Coupled with findings that bariatric surgery confers little to no long-term survival benefit, these observations show that bariatric surgery does not provide an overall societal benefit," says Edward Livingston (JAMA Network, Chicago, Illinois, USA) in an invited critique in the same journal.

"In other words, the indications for bariatric surgery should be viewed in terms of individual patient benefit without anticipating that there will be cost savings to a health care system by offering this treatment."

The study shows that the annual healthcare expenditure over 6 years was similar for 29,820 patients who underwent bariatric surgery and an equal number of patients, matched for variables including age and gender, who did not undergo surgery but had diagnosis of obesity or a closely related condition, such as hyperlipidemia, diabetes mellitus, sleep apnea, or the metabolic syndrome.

The average perioperative cost in the surgery group was US$ 29,517 (€ 22,405). Surgical patients' costs peaked in the second year after surgery and then leveled off. They had lower pharmacy costs than control patients, with these falling by about a third in the 3 years after surgery, but they had substantially higher inpatient costs. Outpatient and professional office costs were similar between the groups.

Overall costs amounted to about $ 9000 (€ 6831) per year for each group, and surgical patients tended to have slightly higher costs than the control patients for most years. Moreover, their costs never dipped below those incurred prior to surgery.

Patients who underwent laparoscopic procedures incurred significantly lower costs than those who had open surgery, but only for the first 2 years after the procedure, and they had slightly higher costs at 5-6 years after surgery.

Study author Jonathan Weiner (Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA) and co-workers note that about 16% of healthcare costs in the USA currently go on obesity and related conditions and that use of bariatric surgery is on the rise.

Livingston says: "In this era of tight finances and inevitable rationing of health care resources, bariatric surgery should be viewed as an expensive resource that can help some patients."

He states: "Patients considered for bariatric surgery should have a complication of obesity that is known to dramatically improve with weight loss surgery. Examples include diabetes and osteoarthritis." He also suggests that the procedure be restricted to patients with "demonstrated compliance to medical and dietary treatment."

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