Economic Impact of Bariatric Surgery

Articles highlighting the return on investment and economic
impact of bariatric surgery.


Economic Impact of the Clinical Benefits of Bariatric
Surgery in Diabetes Patients With BMI >/= 35 kg/m(2).

Klein et al. Sept 2010

PubMed Abstract

ABSTRACT: The medical costs for a type 2 diabetes patient
are two to four times greater than the costs for a patient
without diabetes. Bariatric surgery is the most effective
weight-loss therapy and has marked therapeutic effects on
diabetes. We estimate the economic effect of the clinical
benefits of bariatric surgery for diabetes patients with
BMI >/= 35 kg/m(2). Using an administrative claims database
of privately insured patients covering 8.5 million lives
1999-2007, we identify obese patients with diabetes, aged
18-65 years, who were treated with bariatric surgery identified
using Healthcare Common Procedure Coding System codes. These
patients were matched with nonsurgery control patients on
demographic factors, comorbidities, and health-care costs.
The overall return on investment (RoI) associated with bariatric
surgery was calculated using multivariate analysis. Surgery
and control patients were compared postindex with respect
to diagnostic claims for diabetes, diabetes medication claims,
and adjusted diabetes medication and supply costs. Surgery
costs were fully recovered after 26 months for laparoscopic
surgery. At month 6, 28% of surgery patients had a diabetes
diagnosis, compared to 74% of control patients (P < 0.001).
Among preindex insulin users, insulin use dropped to 43% by
month 3 for surgery patients, vs. 84% for controls (P < 0.001).
By month 1, medication and supply costs were significantly
lower for surgery patients (P < 0.001). The therapeutic benefits of bariatric surgery on diabetes translate into considerable economic benefits. These data suggest that surgical therapy is clinically more effective and ultimately less expensive than standard therapy for diabetes patients with BMI >/= 35


Medication utilization and annual health care costs in
patients with type 2 diabetes mellitus before and after
bariatric surgery.

Makary et al. Aug 2010

PubMed Abstract

OBJECTIVE: To examine the relationship of bariatric surgery
with the use of diabetes medications and with total health
care costs in patients with type 2 diabetes mellitus.

DESIGN: We studied 2235 adults with type 2 diabetes and commercial
health insurance who underwent bariatric surgery in the United
States during a 4-year period from January 1, 2002, through
December 31, 2005. We used administrative claims data to measure
the use of diabetes medications at specified time intervals
before and after surgery and total median health care costs
per year.

SETTING: Seven states in the Blue Cross/Blue Shield Obesity
Care Collaborative.

PATIENTS: Two thousand two hundred thirty-five patients with
type 2 diabetes mellitus who underwent bariatric surgery.

RESULTS: Surgery was associated with elimination of diabetes
medication therapy in 1669 of 2235 patients (74.7%) at 6
months, 1489 of 1847 (80.6%) at 1 year, and 906 of 1072 (84.5%)
at 2 years after surgery. Reduction of use was observed in
all classes of diabetes medications. The median cost of the
surgical procedure and hospitalization was $29,959. In the
3 years following surgery, total annual health care costs
per person increased by 9.7% ($616) in year 1 but then decreased
by 34.2% ($2179) in year 2 and by 70.5% ($4498) in year 3
compared with a preoperative annual cost of $6376 observed
from 1 to 2 years before surgery.

CONCLUSIONS: Bariatric surgery is associated with reductions
in the use of medication and in overall health care costs in
patients with type 2 diabetes. Health insurance should cover
bariatric surgery because of its health and cost benefits.


A Study on the Economic Impact of Bariatric Surgery

Bushwald et al. Sept 2008

PubMed Abstract

OBJECTIVE: To evaluate the private third-party payer return
on investment for bariatric surgery in the United States.

STUDY DESIGN: Morbidly obese patients aged 18 years or older
were identified in an employer claims database of more than
5 million beneficiaries (1999-2005) using International
Classification of Diseases, Ninth Revision, Clinical Modification
code 278.01. Each of 3651 patients who underwent bariatric
surgery during this period was matched to a control subject
who was morbidly obese and never underwent bariatric surgery.
Bariatric surgery patients and controls were matched based
on patient demographics, selected comorbidities, and costs.

METHODS: Total healthcare costs for bariatric surgery patients
and their controls were recorded for 6 months before surgery
through the end of their continuous enrollment. To account
for potential differences in patient characteristics, we
calculated the cost differential by estimating a Tobit model.
A return on investment was estimated from the resulting
coefficients. Costs were inflation adjusted to 2005 US dollars
using the Consumer Price Index for Medical Care, and the
cost savings were discounted by 3.07%, the 3-month Treasury
bill rate during the same period.

RESULTS: The mean bariatric surgery investment ranged from
approximately $17,000 to $26,000. After controlling for
observable patient characteristics, we estimated all costs
to have been recouped within 2 years for laparoscopic surgery
patients and within 4 years for open surgery patients.

CONCLUSIONS: Downstream savings associated with bariatric
surgery are estimated to offset the initial costs in 2 to
4 years. Randomized or quasiexperimental studies would be
useful to confirm this conclusion, as unobserved characteristics
may influence the decision to undergo surgery and cannot
be controlled for in this analysis.

The impact of weight reduction surgery on health-care
costs in morbidly obese patients.

Christou et al. Aug 2004

PubMed Abstract

BACKGROUND: The treatment of obesity and related comorbidities
are significant financial burdens and sources of resource
expenditure. This study was conducted in order to assess
the impact of weight-reduction surgery on health-related

METHODS: This was an observational two-cohort study. The
treatment cohort included patients having undergone weight-reduction
(bariatric) surgery at the McGill University Health Centre
(MUHC) between 1986 and 2002. The control group included
age and gender matched obese patients who had not undergone
weight-reduction surgery from the Quebec provincial health
insurance database (RAMQ). The cohorts were followed for a
maximum of 5 years from inception. The primary outcome measure
was overall direct healthcare costs. Secondary outcomes
included cost analysis by diagnostic category for the treatment
of new medical conditions following cohort inception.

RESULTS: The cohorts were well-matched for age, gender and
duration of follow-up. Patients having undergone bariatric
surgery had significant reductions in mean percent initial
excess weight loss (67.1%, P <0.001) and in percent change
in initial body mass index (34.6%, P <0.001). Bariatric
surgery patients had higher total costs for hospitalizations
(per 1,000 patients) in the first year following cohort
inception (surgery cohort = CDN 12,461,938 dollars; control
cohort = CDN 3,609,680 dollars). At 5 years after cohort
inception, average cumulative costs for operated patients
were CDN 19,516,667 dollars versus CDN 25,264,608 dollars,
for an absolute difference of almost CDN 6,000,000 dollars
per 1,000 patients.

CONCLUSION: Weight-reduction surgery in morbidly obese patients
produces effective weight loss and decreases long-term direct
health-care costs. The initial costs of surgery can be amortized
over 3.5 years.