An analysis of insurance claims data suggests that bariatric surgery does not appear to be associated with reduced overall health care costs in the long term, according to a report published Online First by JAMA Surgery, a JAMA Network publication.1
Bariatric surgery is a well-documented treatment for obesity, which is a significant burden on the U.S. health care system with billions of dollars spent annually to treat obesity and obesity-associated co-existing conditions, according to the study background.
Jonathan P. Weiner, DrPH., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues conducted an analysis of 2002-2008 claims data that compared persons who underwent bariatric surgery with a matched nonsurgical group to analyze health care costs. The study included seven health insurance plans with a total enrollment of more than 18 million persons.
“A major finding of this study is that overall health care resource use among obese individuals undergoing bariatric surgery is relatively stable during the six years following surgery. When these individuals’ health care costs are compared with those of a matched comparison group, total costs are significantly greater in the surgical cohort in the second and third years following surgery, but overall costs of those undergoing surgery are not lower than those of the matched comparison group during follow-up years four through six,” the authors note.
The study results indicate that total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. But the bariatric group’s prescription and office visit costs were lower and their inpatient costs higher. The study also suggests that those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but those differences did not last.
“Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings,” the study concludes.
In an invited critique2, Edward H. Livingston, M.D., of The JAMA Network, Chicago, writes: “Bariatric surgery has dramatic short-term results, but on a population level its outcomes are far less impressive. 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. Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success.”
1. JAMA Surgery. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1504.
2. JAMA Surgery. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1505.