Is Bariatric Surgery for Obesity Cost-Effective?
One of the reasons health insurance companies pay for bariatric surgery for severely obese people is that the extreme weight loss that occurs may improve their overall health afterward. In other words, the surgery is justified because the weight loss makes people healthier, thereby lowering their medical costs.
But bariatric surgery is expensive. Depending on the type of procedure, it costs anywhere from $17,000 to $35,000. So is the surgery truly “cost-effective,” in that it improves health enough to recoup surgery costs?
No, according to a new study of insurance claims data, which found that bariatric surgery does not lower overall health costs in the long term. Researchers analyzed 2002-2008 claims data comparing people who had bariatric
surgery with a similar group of obese people who did not undergo the surgery. They evaluated more than 18 million people from seven health insu
Total Costs Greater in Surgical Group
Overall health care resources in people who had bariatric surgery was “relatively stable” during the six years after surgery, the researchers report. But when compared to people who didn’t have the surgery, total costs were substantially greater in people who had the surgery after two to three years. Additionally, people who had the surgery did have lower prescription and office visit costs than the comparison group. But inpatient costs – or hospitalizations — for people who had the surgery were higher.
The authors write that although their study shows that bariatric surgery “does not reduce overall health care costs in the long term, . . . there is no evidence that any type of surgery is more likely to reduce long-term health care costs.” Thus, more studies are needed to assess other possible benefits of improved health in people who have the procedure instead of just its cost savings.
In an accompanying editorial to the published study, H. Livingston, M.D., deputy editor of the Journal of the American Medical Association in Chicago, writes that the study shows the surgery should be used more sparingly. Even though bariatric surgery has “dramatic short-term results, . . . on a population level its outcomes are far less impressive.”
“In this era of tight finances and inevitable rationing of health-care resources, bariatric surgery should be viewed as an expensive resource that can help some patients,” he adds. “Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success.”
Other Research Finds Cost-Benefit
Still, other research points to a cost-benefit of bariatric surgery. One recently published study indicates that total non-pharmacy costs for people undergoing bariatric surgery were lower than for people not undergoing the surgery, and those costs lasted for 6 years afterward. Additionally, costs for medications such as those used to treat high blood pressure, diabetes, and high cholesterol, were lower in the group that had surgery. The researchers conclude that costs of the surgery may be “recouped” within four years, with “continued effects” to six years after surgery.
No matter what the benefits, bariatric surgery is reserved for people who are severely obese, usually at least 100 pounds over their ideal weight, and who have at least one health condition linked to obesity, such as diabetes. A common type of bariatric surgery, the Roux-en-Y, reduces the size of the stomach and food is sent directly from the stomach to the small intestine. This both keeps you from eating too much and prevents some calories from being absorbed. More and more the procedure is being done with a laparoscope, which is less invasive than traditional surgery and patients tend to have better outcomes than with traditional surgery.
If you are considering bariatric surgery, you should know it is not a quick fix for obesity.
Because it is considered a drastic measure, not everyone is approved by their insurance company to undergo it. Your doctor will ask you questions before performing the surgery. You should be well-informed about the procedure and its risks and benefits. You should also know that you will have to follow a diet and exercise after surgery for the rest of your life. If you overeat, you will most likely regain some or all of the weight you lost. Finally, you must have medical follow-up for the rest of your life.