Impact of Bariatric Surgery on Health Care Utilization and Costs Among Patients With Diabetes

Bleich, Sara N.; Chang, Hsien Yen; Lau, Bryan; Steele, Kimberly; Clark, Jeanne M.; Richards, Thomas M.; Weiner, Jonathan P.; Wu, Albert W.; Segal, Jodi B

doi:10.1097/mlr.0b013e3182290349

Cited by 30 publications

(44 citation statements)

References 26 publications

(25 reference statements)

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“…In the only three studies that monitored patients for a longer period, the results were not consistent [12,17,19]. According to Narbro et al (2002), although it was possible to reduce drug costs for DM and cardiovascular disease through surgical treatment, there was increased use of drugs for treating anemia, vitamin deficiencies, and gastrointestinal disorders and higher associated drug costs [12].…”

Section: Discussionmentioning

confidence: 98%

“…A number of studies identified comorbidity resolution as the main reason for bariatric surgery [3,8,16,17]. In the studies selected for this analysis, we observed that the comorbidities evaluated were not homogeneous ( Table 2).…”

Section: Comorbidities and Drug Use Before And After The Surgical Promentioning

confidence: 95%

“…The range of average preoperative BMIs (35-57 kg/m 2 [48.8±5.2 kg/m 2 ]) showed that patients had met the surgical treatment inclusion criteria. The studies were divided into two groups, smaller studies, which included 39-78 patients [3,4,13,15,16], and larger studies, which included 510-29,820 patients [12,[17][18][19] (Table 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis

et al. 2015

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The aim of this study was to assess drug use and costs before and after bariatric surgery (BS). A systematic review of the literature was carried out using the MeSH terms obesity, bariatric surgery, and drug costs for searches of 10 electronic databases up to July 2014. Data were extracted from the 11 studies (37,720 patients) that fulfilled the inclusion criteria. Where applicable, data were pooled by meta-analysis. The average number of drugs per patient decreased from 3.9 ± 1.86 before surgery to 1.75 ± 1.85 after surgery. Mean reduction in total cost of drugs was 49.8 % over a follow-up duration of 6-72 months. BS is effective for the improvement or resolution of comorbidities and significantly reduces drug use and costs.

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Section: Discussionmentioning

confidence: 98%

Section: Comorbidities and Drug Use Before And After The Surgical Promentioning

confidence: 95%

Section: Study Characteristicsmentioning

confidence: 99%

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Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis

et al. 2015

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“…Gastric banding led to 0.94 life-years gained, 1.34 QALYs gained and a cost-effectiveness ratio of $13,000/QALY. Bleich et al examined healthcare utilization and costs in 7806 individuals with Type 2 diabetes over 6 years after bariatric surgery [71], and reported no reduction in healthcare costs compared with before surgery. The ratio of hospital costs post surgery compared with presurgery was higher in years 2 to 6 after surgery and increased over time (1 year …”

Section: Cost-effectiveness Of Bariatric Surgerymentioning

confidence: 97%

The effect of bariatric surgery on obesity and its complications

Azmi¹,

Alam²,

Ammori³

et al. 2015

Diabetes Management

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Obesity has become a worldwide epidemic that is accompanied by a rise in Type 2 diabetes mellitus. Management of obesity is paramount to prevent the associated mortality and morbidity. Several randomized control trials show that bariatric surgery is an effective method for the treatment of obesity and remission of Type 2 diabetes in the short term. Long-term observational studies have further validated the improvements in weight and Type 2 diabetes as well as cardiovascular events and overall mortality. There is an improvement in microvascular outcomes, in particular retinopathy and nephropathy show promising results but further studies are needed to evaluate hard-end points for neuropathy. Bariatric surgery is cost effective with the cost of surgery being offset by future cost benefits. KEYWORDS Practice points• There is a worldwide increase in obesity and Type 2 diabetes mellitus (T2DM).• Obesity is associated with increased mortality and morbidity.• Bariatric Surgery is a cost-effective treatment for obesity and Type 2 diabetes, which in the long-term is associated with an improvement in mortality.• NICE guidelines recommend that all patients with a BMI of 35 or over who have recent-onset T2DM be assessed for bariatric surgery.• The outcome on weight of the different surgical procedures affects the remission rates of T2DM.• Microvascular outcomes show promising results postbariatric surgery, however, these need to be further evaluated particular on neuropathy.• Careful patient selection is important to achieve the best outcomes post bariatric surgery.There is a worldwide rapid increase in obesity prevalence such that it may be described as an epidemic. Obesity has more than doubled since 1980 such that in 2014 more than 1.9 billion adults were overweight and over 600 million were obese [1]. In 2013, 42 million children under the age of 5 years were overweight or obese [1]. The adverse consequences of this are emphasized when one considers that BMI is a powerful predictor of Type 2 diabetes mellitus (T2DM), cardiovascular (CV) morbidity and mortality [2,3]. There are currently 382 million people in the world with diabetes and this is estimated to reach 592 million by 2035 [4]. Indeed despite the emphasis on malnutrition in the developing world, overweight and obesity are linked to more deaths than being underweight.For reprint orders, please contact: reprints@futuremedicine.com

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“…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.…”

mentioning

confidence: 99%

Does Bariatric Surgery Reduce Health Care Costs?

Dimick

2015

JAMA Surg

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Bariatric surgery is by far the most effective therapy for morbid obesity and obesity-related conditions, especially type 2 diabetes mellitus. Numerous well-designed observational studies and randomized clinical trials show profound weight loss, high rates of comorbidity resolution, improved quality of life, and decreased mortality after bariatric surgery. [1][2][3] Despite these well-known clinical benefits, there is debate about the impact of bariatric surgery on health care expenditures. Bariatric surgery itself is a relatively expensive intervention. Besides the surgical episode itself, there are substantial preoperative costs from testing and referrals to specialists, as well as increased postsurgical costs owing to short-and longer-term complications. 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.Importantly, the authors used a rigorous longitudinal study design-evaluating health care costs over time in patients who had surgery-that allows patients to serve as their own controls. 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. 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. This finding implies that bariatric surgery is certainly not increasing costs as many worry about, and it very well may result in net cost savings in the long term. Second, this study provides important information on the comparative effectiveness of the laparoscopic band vs laparoscopic gastric bypass. Although the laparoscopic band was associated with lower costs and fewer emergency department visits early postoperatively (which has clinical face validity), by 3 years, the laparoscopic gastric bypass was associated with lower total and prescription costs. This conclusively demonstrates that the superior clinical efficacy of laparoscopic gastric bypass demonstrated in clinical trials translates into greater longer-term health care cost savings.This study does leave some important questions to answer. Namely, what happens to health care expendi...

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Impact of Bariatric Surgery on Health Care Utilization and Costs Among Patients With Diabetes

Cited by 30 publications

References 26 publications

Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis

Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis

The effect of bariatric surgery on obesity and its complications

Does Bariatric Surgery Reduce Health Care Costs?

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