Costs and usage of healthcare services before and after open bariatric surgery

Abstract

CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities.There are no studies comparing costs before and after bariatric surgery in Brazil.The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.reSUMO CONTEXTO E OBJETIVO: Indivíduos obesos mórbidos são grandes consumidores de serviços de saúde, com altos custos associados. A cirurgia bariátrica é uma alternativa para melhorar suas comorbidades. Não existem estudos comparando custos antes e após a cirurgia bariátrica no Brasil. O objetivo deste estudo foi analisar os resultados assistenciais e gastos diretos de pacientes obesos mórbidos submetidos à cirurgia bariátrica. TIPO DE ESTUDO E LOCAL: Coorte histórica de pacientes assistidos por um plano de saúde na cidade de Belo Horizonte, Minas Gerais. MÉTODOS: Foram incluídos na análise todos os serviços de saúde e seus custos associados: hospitalizações, permanência hospitalar, consultas eletivas e de emergência e exames. A análise foi tratada como total quando incluía todo o ano anterior e posterior à cirurgia, e parcial quando excluía os trimestres adjacentes à cirurgia. RESULTADOS: Para 382 pacientes obesos operados, houve 53 internações um ano antes e 95 um ano após a cirurgia (P = 0,013). As principais indicações para internação pós-procedimento foram complicações relacionadas ao trato gastrointestinal. O custo parcial médio quase dobrou no período pós-operatório (US$ 391,96 versus US$ 678,31). Em análise de s...

Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review

“…Fifty six percent ( n = 43) of studies' data is predominantly is sourced from or originated from the USA . Studies also originated from Sweden 10% ( n = 8), Australia 8% ( n = 6), UK 8% ( n = 6), Canada , and the remainder of the included studies each for France ( n = 2),Germany , (Austria, Italy, Spain) , Spain , Norway , Portugal , the Netherlands , Finland , South Korea , Brazil ( n = 2) and Mexico . Two studies reported data from three countries (Table ).…”

“…Seventy six studies reported a time horizon. Of those that reported a time horizon, 42% ( n = 32) adopted a timeframe of ≤5 years and 53% of these studies reported results for ≤2 years ( n = 17) (mostly cost and cost analyses). Some cost and cost analyses reported a longer time horizon of 6–10 years ( n = 12, 16%) or 11–20 years ( n = 3, 4%) .…”

“…Just under half of the included studies adopted a retrospective, observational study design ( n = 35, 45%) , and 34% of these studies originated from the USA. Cohort matching techniques included studies that matched the surgical cohort with a control by adopting rigorous propensity score matching methodologies or other methodologies by matching particular variables such as comorbidity (most commonly T2DM and cardiovascular) and/or age and gender .…”

Bariatric surgery. Analysis of hospital admissions for obesity in the Brazilian Public Health System (SUS) in Sao Paulo

“…This study described hospital admissions related to obesity only that were registered in the Unified Health System number of hospitalization days [15][16] .…”

Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications

“…Second, variations in treatments and costs across payer types (private vs. public) and countries have resulted in differing return on investment timelines [37,55,56,[68][69][70][71]. Lastly, many studies examine an arbitrary sample of patients receiving BMS or [75] There is only one reference center for BMS for every 4 million inhabitants, leading to long waiting lists [76] Insufficient investment in hospital infrastructure…”