A qualitative investigation of the health economic impacts of bariatric surgery for obesity and implications for improved practice in health economics

Abstract

Obesity is an economic problem. Bariatric surgery is cost-effective for severe and resistant obesity. Most economic evaluations of bariatric surgery use administrative data and narrowly defined direct medical costs in their quantitative analyses. Demand far outstrips supply for bariatric surgery. Further allocation of health care resources to bariatric surgery (particularly public) could be stimulated by new health economic evidence that supports the provision of bariatric surgery. We postulated that qualitative research methods would elicit important health economic dimensions of bariatric surgery that would typically be omitted from the current economic evaluation framework, nor be reported and therefore not considered by policymakers with sufficient priority. We listened to patients: Focus group data were analysed thematically with software assistance. Key themes were identified inductively through a dialogue between the qualitative data and pre-existing economic theory (perspective, externalities, and emotional capital). We identified the concept of emotional capital where participants described life-changing desires to be productive and participate in their communities postoperatively. After self-funding bariatric surgery, some participants experienced financial distress. We recommend a mixed-methods approach to the economic evaluation of bariatric surgery. This could be operationalised in health economic model conceptualisation and construction, through to the separate reporting of qualitative results to supplement quantitative results.

Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model

“…Importantly, 45.8% of these potential bariatric surgery candidates had no private health insurance [24]. Our recent qualitative health economics study found that many of the people who partially or fully self-funded their bariatric surgery experienced economic burden to do so [25]. This qualitative study also found that some people were accessing their superannuation to fund their surgery because they either had no private health insurance or they had to pay the concomitant health insurance gap [25].…”

“It is not a scientific number it is just a feeling”: Populating a multi‐dimensional end‐of‐life decision framework using deliberative methods

“…In terms of method, recent studies within health economics have also found value in using a deliberative approach to enable reflection and collect both qualitative and quantitative data simultaneously (Gansen, Klinger, & Rogowski, 2019; Kinghorn, 2019). There have also been attempts to use qualitative methods to enhance understanding of the values of relevant stakeholders that can be incorporated into decision‐making around health and care services (Campbell et al., 2018; Kinghorn & Coast, 2019). The extent of this work remains limited, however, and methodological issues such as the extent of deliberation that is optimal in these contexts have not been explored.…”

Administrative Data Use in National Registry Efforts: Blessing or Curse?

“…Another challenge in estimating health-services utilization with administrative data is that often, services covered by major insurance companies are more likely to be recorded, while many out-of-pocket expenses are not captured 57 . Also, certain diagnoses are less likely to be coded.…”