Economic Value of Greater Access to Bariatric Procedures for Patients With Severe Obesity and Diabetes

Abstract

Objective: Designing optimal insurance is important to ensure access to care for individuals that are most likely to benefit. We examined the potential impact of lowering patient cost-sharing for bariatric procedures. Methods: After defining 10 subgroups by body mass index (BMI) and type 2 diabetes mellitus (T2DM), we analyzed the National Health and Nutrition Examination Survey datasets to estimate the prevalence of each subgroup. The MarketScan claims database provided utilization rates and costs of bariatric procedures. Using an existing cost-effectiveness model, we estimated the economic value of bariatric procedures under various cost-sharing levels (0%–25%) with 2 frameworks: (1) a traditional cost-effectiveness analysis and (2) a new approach that incorporates utilization effects across subgroups. Results: The utilization rate was higher among individuals with T2DM than those without T2DM (90.4 vs. 59.1 cases per 100,000) for bariatric procedures, which were more cost-effective for those with T2DM and a higher BMI. After accounting for utilization effects, the economic value of bariatric surgery was $177 and $63 per individual from a lifetime and a 5-year time horizon, respectively. Under no patient cost-sharing for individuals with BMI≥40 and T2DM, utilization rates were expected to increase by 21 cases per 100,000, resulting in additional $2 realized value per patient and $7.07 million in returns at the US population level. Conclusions: Cost-sharing is a barrier to uptake of a clinical and cost-effective treatment for severe obesity. Reducing cost-sharing for patients with severe obesity and T2DM could potentially increase the utilization of bariatric procedures and result in greater economic value to payers.

Bariatric surgery is a cost‐saving treatment for obesity—A comprehensive meta‐analysis and updated systematic review of health economic evaluations of bariatric surgery

“…Since September 2015, n = 24 health economic evaluations regarding bariatric surgery (with comparison to conventional treatment/no surgery or “before” versus “after” comparison) have been published. The distribution of economic reporting was similar to our previous narrative review, with 10 (42%) from European countries (UK 4, Denmark 2, Belgium 1, Italy 1, Germany 1, and Spain 1), six (25%) from the USA, three (13%) from Brazil, two (8%) from Australia and New Zealand, one (4%) each from Canada, Turkey, and China . Of special note was that 21% of studies (five out of n = 24) derived from developing countries, with two of these studies informed by Asian cohorts …”

“…Over a longer time horizon (≥ 10 years), bariatric surgery was a cost‐saving alternative to usual care for people with obesity and T2DM and still cost‐effective in patients without T2DM . Subgroup analyses also showed that bariatric surgery was consistently more cost‐effective as a person with obesity's initial BMI increased . A recent modelling study further identified male patients with a BMI between 40 and 50 kg/m 2 as a subgroup that benefited from bariatric surgery in terms of cost‐effectiveness .…”

“…After removing duplicate papers 1096 studies remained for title and abstract screening, with 63 studies included for full‐text review. Of these, 24 partial and full health economic evaluation studies were included in the updated systematic review . These studies were also assessed against the eligibility criteria for quantitative meta‐analyses together with the n = 77 eligible health economic evaluations from our previous systematic review (low part of Figure ).…”

“…Forty‐two percent of the included health economic evaluations (n = 10, and mainly partial health economic evaluations) adopted a short‐term time horizon (<10 years), and 70% (n = 7) of these studies reported results for ≤5 years . The majority of studies (n = 14, 58%) adopted a long‐term time horizon (≥10 years or lifetime); nevertheless, just one fifth (n = 3) of full health economic evaluations of bariatric surgery did not account for the cost of complications and reoperations after bariatric surgery . On the other hand, two‐thirds (n = 6) of partial health economic evaluations failed to consider health care costs due to complications and/or reoperations following the primary bariatric surgical procedure …”

Temporal Effects of Sleeve Gastrectomy on Glucose-Insulin Homeostasis and Incretin Hormone Response at 1 and 6 Months

“…Increased rates of obesity contribute a substantial financial burden, especially in the USA, where obesity is associated with an additional annual medical expenditure of $1900 per person. This equates to a national excess healthcare expenditure of $150 billion for people with obesity [2]. Bariatric surgery is an effective treatment for morbid obesity and is associated with at least 80% remission of impaired glucose tolerance (IGT) and type 2 diabetes (T2D) [3][4][5][6][7].…”