Assessing Real World Effect of Laparoscopic Bariatric Surgery on Healthcare Costs- a Retrospective Matched Cohort Study using a U.S. Administrative Claims Database
Journal Title: Journal of Endocrinology and Diabetes - Year 2016, Vol 3, Issue 5
Abstract
Background: Bariatric surgery is considered an efficacious procedure for stimulating significant weight loss and improving obesity-related co morbidities among severely obese persons; however, the effect of bariatric surgery on healthcare costs is debated. Objective: To evaluate the effect of 3 types of laparoscopic bariatric surgery procedures on healthcare costs. Methods: Patient’s ≥18 years of age who had laparoscopic bariatric surgery between January 2006 and December 2013were identified from the optum clinformatics administrative claims database. Patients who were identified as having had Laparoscopic Adjustable Gastric Banding (LAGB), Gastric Bypass (LRYGB), or Sleeve Gastrectomy (LSG), were matched to medically-managed patients (controls) based on age, sex, obesity category, insurance type, obesity-related co morbidities, and baseline average monthly healthcare cost. Medication costs for treatment of selected obesityrelated co morbidities (type 2 diabetes [T2DM], dyslipidemia, and hypertension), (non-medication) medical costs, and the combination of these costs (combined treatment costs) were measured for every 6 months up to 5 years after the surgery or an assigned index date for controls (followup). Healthcare costs were compared between the surgical and control cohorts using mixed models for repeated measurements. Results: Patients who had LAGB (N=4,208, mean age=46.3 years), LRYGB (N=4,308, mean age=46.4 years), and LSG (N=545, mean age=45.1 years) and patients in the control cohort (N=9,061, mean age=46.4 years) were similar in age and the majority of patients in each study cohort were female (69.4%-75.8%).By the 5th year of follow-up, all categories of adjusted monthly healthcare costs were significantly lower for the LRYGB cohort than the control cohort (medication, $156 vs. $245, P < 0.001; medical, $650 vs. $1,019, P< 0.001;combined treatment, $977 for LRYGB vs. $1,354 for controls, P=0.001). Likewise, adjusted monthly healthcare costs were significantly lower for the LSG cohort than the control, but the LSG results are inclusively because of the recent uptake of LSG. The adjusted monthly combined treatment and medical costs of the LAGB cohort tended to not differ significantly from those of the control cohort; however, by the end of follow- this cohort had significantly lower medication costs ($208 for LAGB vs. $245 for controls, P=0.030). The magnitude and statistical significance of cost differences in sub-analyses of patients with selected obesity-related co morbidities tended to be greater and tended to indicate lower costs in the surgical cohorts by the end of follow-up. Time to full ROI was realized for the LRYGB cohort in approximately 4 years among patients with T2DM and in approximately 3 years among patients with T2DM using insulin Conclusion: In this retrospective analysis of a large real-world claims database, patients who had laparoscopic bariatric surgery incurred lower medication costs for the treatment of T2DM, dyslipidemia, and hypertension compared to medically-managed controls up to 5 years post-surgery. LRYGB was associated with the greatest reduction in medication costs and sustained lower combined treatment costs in comparison to medicallymanaged controls over the 5 year follow-up period. LAGB did not demonstrate sustained lower cost vs control, and more study is needed to evaluate the long term impact of LSG.
Authors and Affiliations
John Dawson, Eric Bour, Andrew Yoo, Gang Li, Natalie Heidrich, Anuprita Patkar
Keywords
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- EP ID EP333693
- DOI 10.15226/2374-6890/3/5/00164
- Views 106
- Downloads 0
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