Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs

Abstract

BackgroundWe undertook a survey of all bariatric centres in Scotland in order to describe current pre- and post-operative care, to estimate their costs and explore differences in financial impact.MethodsA questionnaire was distributed to each health centre. Descriptive statistics were used to present average cost per patient along with 95% confidence intervals, and the range of costs.ResultsResults show nearly a five-fold difference in costs per patient for pre-operative services (range £226 - £1071) and more than a three-fold difference for post-operative services (range £259 - £896).ConclusionsThere is a lack of evidence base and a clear requirement for the evaluation of bariatric surgical services to identify the care pathways pre- and post-surgery which lead to largest improvements in health outcomes and remain cost-effective.Electronic supplementary materialThe online version of this article (10.1186/s40608-018-0223-3) contains supplementary material, which is available to authorized users.

Clinical outcomes and adverse events of bariatric surgery in adults with severe obesity in Scotland: the SCOTS observational cohort study

“…The low prioritisation of bariatric surgery within the UK and the strict criteria for access to surgery, including complex pre-surgical pathways and pre-surgical weight-loss requirements, 67 results in low numbers of individuals with severe obesity actually receiving surgery. Those receiving surgery generally do so after many years of alternative conservative interventions, at a point when their mean BMI is extremely high, at around 45 kg/m 2 , and they are at a median age of 47 years.…”

“…Pre-and postop care is a major component of the total cost of bariatric surgery. 67 However, anecdotal evidence suggests that bariatric surgery care pathways vary considerably, including clinical psychology provision. International bariatric guidance, while based on best practice, does not specify the optimal model of care 69,70 and there is little evidence of whether intensive pre-and postop care improves outcomes and is cost-effective compared to less intensive care.…”

Design and evaluation of a new nurse-led case management intervention for bariatric surgery patients

“…The latest statistics from the World Health Organization (WHO) show that 1.9 billion adults are overweight, and more than 650 million adults are obese, with a body mass index (BMI) greater than 40 kg/m2. Obesity high prevalence demands a high priority intervention [2] .…”

SurgiCal Obesity Treatment Study (SCOTS): a prospective, observational cohort study on health and socioeconomic burden in treatment-seeking individuals with severe obesity in Scotland, UK

“… 3 Similarly, levels of severe obesity have risen in the UK with 2.9% of all adults in England 4 and 4% of all adults in Scotland now estimated to have a BMI ≥40 kg/m 2 . 5 …”

“…The low prioritisation of bariatric surgery within the UK and the strict criteria for access to surgery, including complex pre-surgical pathways and pre-surgical weight-loss requirements, 5 results in low numbers of individuals with severe obesity actually receiving surgery. Those receiving surgery generally do so after many years of alternative conservative interventions, at a point when their mean BMI is extremely high, at around 45 kg/m 2 , and they are at a median age of 47 years.…”