A research team including VA Medical Center, Durham, Duke University, Kaiser Permanente Washington Health Research Institute, University of Washington, University of California and the Chicago-based Northwestern University conducted a study and determined that bariatric surgery doesn’t equate to reduced healthcare costs in obese veterans 10 years onward post operation.
What is Bariatric Surgery?
Bariatric surgery represents a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).
The National Institutes of Health (NIH) recommends a bariatric surgery for obese people with a body mass index (BMI) of at least 40 and for people with BMI of at least 35 and serious coexisting medical conditions such as diabetes.
With 9,954 veterans facing severe obesity (BMI of 35Kgm2 or greater), the participants broke down to 74% make with an average age of 52 years old at the start of the study. The investigators sought to compare healthcare costs between participants who underwent bariatric surgery versus those that did not.
The team carried out a number of surgeries from Roux-en-Y gastric bypass to sleeve gastrectomy to adjustable gastric banding. The most common was Roux-en-Y gastric bypass representing 74% of the surgical procedures.
The results evidenced that the total cost of healthcare was greater three years before surgery as well as two years after versus those patients who had no surgery. Total healthcare costs converged with the two groups to comparable levels from between five and ten years after those ho in the surgery group had the procedure.
Although the study team reported that overall drug costs were less for those subjects in the bariatric surgery category the savings, however, was offset by more inpatient and non-pharmacy outpatient costs.
Consequently the research suggests the value of bariatric surgery lies not in healthcare cost reduction but in associations with improvements in health.
Valerie A. Smith, DrPH, Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
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