NEW ORLEANS — Although not cost-saving, bariatric surgery appears to be a good value for the money, results from a large single-center study showed.
“The long-term cost-effectiveness of bariatric surgery will largely depend on the natural history and extent of late postsurgical complications and costs,” Dr. William H. Herman said at the annual scientific sessions of the American Diabetes Association.
To better understand the cost-effectiveness of bariatric surgery in a managed care population, Dr. Herman and his associates studied 221 patients who underwent Roux-en-Y procedures in a Southeastern Michigan HMO in May 2001-June 2005. Patients completed the EQ-5D, a tool used to measure health-related quality of life before and after bariatric surgery.
The patients' mean age was 42 years, 88% were female, and body mass index before surgery was 52 kg/m
Nearly two-thirds (64%) had open surgical procedures. The remainder had laparoscopic procedures. One year after surgery, the mean BMI fell from 51 to 31 in women and from 59 to 35 in men. Overall, patients dropped from a mean weight of 320 pounds to a mean of 192 pounds, a loss of nearly 130 pounds in each person. The average BMI fell from 52 to 31, excess weight fell from 191 pounds to 64 pounds, and patients reported that their comorbidities were improved. For example, 98% reported improvements in hypertension, 100% reported improvements in diabetes, and 92% reported improvements in OSA.
Total per-member costs were about $600 per month in the 6 months prior to surgery, dropped to about $400 per month in the 12 months after surgery, then rose to about $600 per month after 1 year post surgery.
“In the 6 months before bariatric surgery, there was some ramp-up in outpatient pharmacy costs and, not unexpectedly, an increase in clinic costs and diagnostic and laboratory testing likely related to the preoperative period,” Dr. Herman said. “Following bariatric surgery there was a dramatic reduction in outpatient pharmacy costs but some increase in inpatient costs, which seemed to increase the year following surgery.”
When the researchers prospectively assessed presurgical quality of life, they found that the average health utility scores improved by 0.14 1 year after surgery.
In analyses that took a lifetime time horizon, adopted a payer perspective, and discounted costs and health utilities at 3% per year, the cost-utility ratio for bariatric surgery was about $15,000 per quality-adjusted life-year gained, said Dr. Herman, who is an adviser to Johnson & Johnson and Sanofi-Aventis, and a consultant to Amylin Pharmaceuticals Inc.
After surgery we saw 'a dramatic reduction in outpatient pharmacy costs but some increase in inpatient costs.' DR. HERMAN