Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T13:27:40.709Z Has data issue: false hasContentIssue false
  • English
  • Français

BEFORE-AND-AFTER STUDY: DOES BARIATRIC SURGERY REDUCE HEALTHCARE UTILIZATION AND RELATED COSTS AMONG OPERATED PATIENTS?

Published online by Cambridge University Press:  18 January 2016

Silvana Marcia Bruschi Kelles ,
Carla Jorge Machado  and
Sandhi Maria Barreto
Silvana Marcia Bruschi Kelles
Affiliation:
Unimed BH, Health Technology Assessment Group – GATS; Faculdade de Medicina da Universidade Federal de Minas Geraissilvanakelles@gmail.com
Carla Jorge Machado
Affiliation:
Faculdade de Medicina da Universidade Federal de Minas Gerais, Centro de Pósgraduação
Sandhi Maria Barreto
Affiliation:
Faculdade de Medicina da Universidade Federal de Minas Gerais, Centro de Pósgraduação
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Healthcare use and costs are about 81% higher for morbidly obese individuals compared to non-obese persons, and 47% higher compared to the non-morbidly obese population. The benefits of bariatric surgery for health are well established, but its mid-term impact on healthcare use and costs remains controversial.

Methods: This study examines the trends in healthcare use and costs in a Brazilian cohort during a 4-year period before and after surgery. Healthcare use and direct costs related to inpatients and outpatients were retrieved from a healthcare insurance company database from which all cohort members were selected.

Results: Between 2004 and 2010, 4,006 individuals underwent bariatric surgery. Most patients were female (80%) with a mean age of 36.2 years and a mean body mass index of 42.8 kg/m2. Elevated blood pressure was present in 38% of cases and diabetes was found in 12.5% of subjects. Hospital admissions increased consistently after surgery, even after excluding hospitalizations for esthetic surgery and pregnancy-related care. The most prevalent conditions in this group were gastrointestinal diseases. Emergency department visits increased after bariatric procedures, in particular for genitourinary and hematologic problems. Adjusted costs were higher after surgery as assessed during a 4-year follow-up period.

Conclusion: Results indicate that costs and hospital admissions after bariatric surgery increase following this procedure, even when elective interventions are excluded. Healthcare providers and policy makers need to be aware that a decrease in obesity-related diseases following bariatric surgery does not reduce healthcare use and costs.

Keywords

Cost analysisHealthcare services evaluationBariatric surgeryFollow-up studiesMorbid obesity
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 31 , Issue 6 , 2015 , pp. 407 - 413
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Flegal, KM, Carrol, MD, Ogden, CL, Johnson, CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA. 2002;288:1723–1737.CrossRefGoogle ScholarPubMed
2. Arteburn, DE, Maciejewski, ML, Tsevat, J. Impact of morbid obesity on medical expenditures in adults. Int J Obes. 2005;29:334–339.CrossRefGoogle Scholar
3. Brasil, Ministério da Saúde, Ministério do Planejamento, Orçamento e Gestão. Pesquisa de Orçamentos Familiares 2008–2009: Antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. Brasília: IBGE; 2009:130.Google Scholar
4. Colquitt, JL, Picot, J, Loveman, E, Clegg, AJ. Surgery for obesity. Cochrane Database Syst Rev. 2009;15:CD003641.Google Scholar
5. Flum, DR, Belle, SH, King, WC, et al. Longitudinal Assessment of Bariatric Surgery (LABS) consortium. N Engl J Med. 2009;361:445–454.Google Scholar
6. Maciejewski, ML, Livingston, VA, Smith, VA, et al. Health expenditures among high-risk patients after gastric bypass and matched controls. Arch Surg. 2012;147:633–640.Google Scholar
7. Agren, G, Narbro, K, Jonsson, E, et al. Cost of in-patient care over 7 years among surgically and conventionally treated obese patient. Obes Res. 2002;10:1276–1283.CrossRefGoogle Scholar
8. Cremieux, PY, Buchwald, H, Shikora, A, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14:589–596.Google Scholar
9. Finkelstein, EA, Allaire, BT, Burgess, SM, Hale, BC. Financial implications of coverage for laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2011;7:295–303.Google Scholar
10. Christou, NV, Sampalis, JS, Liberman, M, et al. Surgery decreases long-term mortality, morbidity and health care use in morbidly obese patients. Ann Surg. 2004;240:416–424.Google Scholar
11. Klein, S, Ghosh, A, Cremieux, PY, Eapen, S, McGavock, TJ. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI≥ 35 kg/m2 . Obesity. 2011;19:581–587.Google Scholar
12. Bleich, SN, Chang, HY, Lau, B, et al. Impact of bariatric surgery on health care utilization and costs among patients with diabetes. Med Care. 2012;50:58–65.CrossRefGoogle ScholarPubMed
13. McEwen, LN, Coelho, RB, Baumann, LM, et al. The cost, quality of life impact, and cost-utility of bariatric surgery in a managed care population. Obes Surg. 2010;29:919–928.Google Scholar
14. Zingmond, DS, McGory, MI, Ko, CY. Hospitalization before and after gastric bypass surgery. JAMA. 2005;294:1918–1924.Google Scholar
15. Weiner, JP, Goodwin, SM, Chang, HY, et al. Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg. 2013;148:555–562.Google Scholar
16. Neovius, M, Narbro, K, Keating, C, et al. Health care use during 20 years following bariatric surgery. JAMA. 2012;308:1132–1141.Google Scholar
17. Abell, TL, Minocha, A. Gastrointestinal complications of bariatric surgery: Diagnosis and therapy. Am J Med Sci. 2006;331:214–218.Google Scholar
18. Kulkarni, A, Jameson, SS, Woodcock, S, Muller, S, Reed, MR. Does bariatric surgery prior to lower limb joint replacement reduce complications? Surgeon. 2011;9:18–21.Google Scholar
19. Encinosa, WE, Bernard, D, Chen, CC, Steiner, CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44:706–712.Google Scholar
20. Drygalski, A, Andris, DA. Anemia after bariatric surgery: more than just iron deficiency. Nutr Clin Pract. 2009;24:217–226.CrossRefGoogle Scholar
21. Vargas-Ruiz, AG, Hernández-Rivera, G, Herrera, MF. Prevalence of iron, folate and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obs Surg. 2008;18:288–293.Google Scholar
22. Ricci, C, Gaeta, M, Rausa, E, et al. Long-term effects of bariatric surgery on type II diabetes, hypertension and hyperlipidemia: A meta-analysis and meta-regresion study with 5 year follow-up. Obes Surg. 2015;25:397–405.Google Scholar
23. Livingston, EH. Is bariatric surgery worth it? Comment on “Impact of bariatric surgery on health care costs of obese persons”. JAMA Surg. 2013;148:56.Google Scholar
Supplementary material: File

Bruschi Kelles supplementary material

Tables S1-S3

Download Bruschi Kelles supplementary material(File)
File 27.9 KB