Bariatric Surgery Resolves Diabetes, Saves Money

Bariatric Surgery Resolves Diabetes, Saves Money

By Charles Bankhead, Staff Writer, MedPage Today
Published: August 17, 2010
Reviewed by Robert Jasmer, MD;Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Three-fourths of patients with type 2 diabetes were able to stop taking medications six months after undergoing bariatric surgery -- and almost 85% no longer needed drug treatment at two years -- cutting their healthcare costs, according to a review of health insurance records.

The analysis of insurance claims data for more than 2,200 adults with type 2 diabetes who underwent bariatric surgery found that -- despite the $30,000 median price tag for the procedure and hospitalization -- the surgery also saved money in the long run, Martin A. Makary, MD, of Johns Hopkins, and co-authors reported.

While annual healthcare costs increased by 9.7% in the first year after bariatric surgery, costs decreased by 34% in the second year, and dropped by 70.5% in the third year, compared with preoperative expenditures, the team wrote in the August issue of the Archives of Surgery.

"Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health," Makary and co-authors commented.

"Coverage of bariatric surgery should be available to all obese patients who meet criteria, regardless of their degree of coverage provided the patient possess the appropriate degree of personal health responsibility and access to a physician in the event of a surgical complication," they added.

Bariatric surgery results in long-term weight loss, improved lifestyle, and decreased mortality among obese patients -- factors that have contributed to a 200% increase in the number of procedures over the past five years, the authors noted.

However, limited data have accumulated regarding the effects of surgery on diabetes and diabetes-related healthcare costs.

To examine the impact of bariatric surgery on diabetes, Makary and co-authors analyzed claims data from Blue Cross/Blue Shield health plans covering 15.9 million people in seven states. They identified 2,235 adults with type 2 diabetes who had bariatric surgery from January 2002 through December 2005.

The authors used administrative claims data to assess use of diabetes medications at specified intervals before and after surgery. They also determined median healthcare costs per year.

Prior to surgery, 1,918 (85.8%) of the patients were taking at least one diabetes medication, and the number of medications per patient averaged 4.4.

Within six months of surgery, 1,669 of 2,235 (74.7%) patients did not require diabetes medications. The proportion increased to 80.6% (1,489 of 1,847) at one year and to 84.5% (906 of 1,072) at two years.

Roux-en-Y gastric bypass surgery accounted for 84.2% of the bariatric procedures. The median cost for all procedures (including hospitalization) was $29,959.

The patients' total healthcare expenditures averaged $6,376 per year in the one to two years prior to surgery. In the first year after surgery, expenditures increased by 9.7% ($616) then decreased by 34.2% ($2,179) in the second year, and by 70.5% ($4,498) in the third postoperative year.

The findings are consistent with data reported the past two years at the American Society of Metabolic and Bariatric Surgery meeting. Multiple studies documented high rates of diabetes resolution following surgery, and investigators in one study employed statistical modeling to estimate that bariatric surgery paid for itself in four years, two years in patients with diabetes.

The study was supported by the Agency for Healthcare Research and Quality and by the Blue Cross/Blue Shield Obesity Care Collaborative.

The authors reported that they had no relevant disclosures.

Primary source: Archives of Surgery
Source reference:
Makary MA, et al "Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery" Arch Surg 2010; 145: 726-731.

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