A recent study suggests that even with weight loss surgery, the formerly obese are still costly to the medical system, at least in the first few years. The prior evidence that weight loss surgery saved money in the long run was based primarily on young, obese females, who are the most likely to HAVE bariatric surgery and save money throughout their health-care cycle. For example, people like me: a relatively straight-forward case of morbid obesity. Gastric bypass may have kept me from developing costly issues related to my obesity.
Weight-loss surgery may not cut medical costs - KTVN-
"These three-year findings suggest that the return on investment for bariatric surgery isn't seen," said lead researcher Matthew Maciejewski, from the Center for Health Services Research in Primary Care at the Durham VA Medical Center, in North Carolina.
"It is possible, however, that if we could follow these [patients] for another three to five years, cost reduction may be seen," he said.
Bariatric surgery improved these patients' health in the short term, but without further weight loss or other lifestyle modifications, their risk remains high, he added.
Maciejewski said these patients, like most patents who have weight-loss surgery, gain much of the weight back, which may be why costs remain the same as before surgery.
The report was published in the July issue of the journal Archives of Surgery.
Download study -
Surgeons use risk-benefit analysis in our decisions to operate on specific patients. Rarely do we consider the economic implication, instead using the assumption that an individual would want enhanced quantity or quality of life, regardless of cost. This decision-making process is further supported by a separation of those who receive the benefit and those who pay the bill. However, when surgeons want to justify a new procedure or piece of equipment, economic benefit is often argued. Those contemplating paying for the procedure will balance expense with the improvement of quantity or quality of life for the insured.
Bariatric surgery clearly reduces obesity-related comorbidities and has been touted to reduce overall costs.1Most of these studies examined a predominantly younger female cohort that represents most bariatric patients. True economic costs are hard to quantify because patients are mobile, expenditures occur in multiple disparate realms, and charges do not reflect actual expenditures. The study by Maciejewski et al2provides insight into a different group of patients: veterans treated in a truly integrated delivery system. Utilization of resources is efficiency captured, and the cost structure is standardized across the system. Comparing 847 patients undergoing bariatric surgery with 847 propensity-matched controls, the authors did not demonstrate a significant decrease in health care expenditures in the 3 years after the bariatric procedures."
For the study, Maciejewski's team looked at health-care spending in nearly 850 U.S. military veterans who had weight-loss surgery, comparing them to a similar number of veterans who didn't. The researchers analyzed expenditures for the three years before and after surgery.
The researchers found that in the years before surgery, hospital inpatient and outpatient costs for people who had bariatric surgery were about $600 lower than for those who didn't have the procedure. In the six months before surgery, however, the costs were $28,400 higher, including the operation.
Costs were almost $4,400 higher in the first six months after surgery, but then dropped to about the same level as before the procedure, the researchers found.
These findings, however, may only apply to this particular group of patients, who were mostly male, older and sicker than other patients who have weight-loss surgery, the researchers noted. In other groups, the procedure may reduce health-care spending.
Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City, said patients should not be looking for a return on investment from any medical procedure.
"We do this medical procedure to make people improve medically -- get rid of their diabetes, their sleep apnea -- and feel better about themselves and let them have an improved quality of life," he said.
Roslin said the notion of cost reduction was something that "people created to try to get coverage for bariatric surgery. I don't believe, in a system like ours, there will ever be a return on investment for any medical procedure."
However, as we know some people simply DO become more expensive throughout the bariatric surgery journey. *points to self*
I cannot imagine the costs of my care without private health insurance in the last nine years. Thanks to Mr. for being employed steadily, because WOW. We still pay ridiculous co-pays, but I have been covered.
Before weight loss surgery, I had little expenditures in terms of health-care, but after, I have many. Some related -- some perhaps related -- to the fact that I had gastric bypass surgery. My situation is NOT a very common result, however, without my husband's health coverage, I would be one expensive public healthcare patient!
PS. Also worth mentioning, WLS patients who become healthier - don't die as fast - and cost more.
Sorry about that.
Sax HC. Questioning the Economics of Bariatric Surgery: Comment on âHealth Expenditures Among High-Risk Patients After Gastric Bypass and Matched Controlsâ. Arch Surg. 2012;147(7):640-641. doi:10.1001/archsurg.2012.1021.
