Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass

Abstract

IMPORTANCE There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: −0.6; 95% CI, −0.9 to −0.4 and −0.4; 95% CI, −0.6 to −0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001). CONCLUSIONS AND RELEVANCE Both laparoscopic AGB and RYGB were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by 3 years postsurgery. On the other hand, RYGB was associated with increased ED visits in the 2 years after surgery. Clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.

Five-year direct medical costs and comorbidities after bariatric surgery of obese patients with type 2 diabetes mellitus: A population-based propensity score-matched study

“…Besides, comorbidity profiles of both groups were tracked for 60 months, providing an overview of changes of comorbidities. Also, as most previous comparative cost analyses on bariatric surgery did not include exploratory analyses [20,22,36,37], this study also added current knowledge on medical costs of bariatric patients in subgroups, which allowed easy estimation of annual direct medical costs of surgical patients with different health conditions.…”

Does Bariatric Surgery Reduce Health Care Costs?

“…Studies evaluating the longer-term health care costs have shown mixed results. [4][5][6] The study in this issue of JAMA Surgery by Lewis et al 7 brings important new data to this debate. Using a unique data source, private payer claims from across the United States, the authors were able to measure health care expenditures (from the payer perspective) over time for patients undergoing laparoscopic adjustable gastric banding and laparoscopic gastric bypass procedures.…”

“…In many ways, this is superior to using a nonsurgical cohort of control individuals, as there is no way of knowing whether patients who do not have surgery are truly similar to those who do have surgery. The study design used by Lewis et al 7 assumes that an individual's health care spending trend will continue on a similar trajectory (a slow upward trend) if they do not have surgery, which seems quite reasonable. This study has 2 very important findings.…”

“…This study has 2 very important findings. 7 First, at 3 years after surgery, there was a significant change in trajectory of health care expenditures, with a flattening of the trend in total health care costs and prescription drug costs. Without surgery, it is most likely that this trend would have followed the upward trend demonstrated in the preoperative period.…”

“…Namely, what happens to health care expenditures beyond 3 years? As the authors pointed out, if this flattening of the cost trend continues, bariatric surgery may be a costsaving procedure, 7 which has important implications for expanding insurance coverage. Moreover, how do expenditures for laparoscopic sleeve gastrectomy compare with gastric bypass?…”