In the Journals

Bariatric surgery fails to reduce overall health care costs among US veterans

A cohort of older veterans with obesity who underwent bariatric surgery experienced an initial drop in pharmacy-related costs when compared with matched adults who did not undergo surgery, but overall health care costs remained comparable between groups during 10 years of follow-up, according to findings published in JAMA Surgery.

“It is unclear whether bariatric surgery is associated with lower long-term health care expenditures because, to our knowledge, few randomized clinical trials have examined health care expenditures, and most observational studies have examined expenditures only up to 2 to 3 years after surgery,” Valerie A. Smith, DrPH, of the Center of Innovation to Accelerate Discovery and Practice Transformation at Durham VA Medical Center, North Carolina, and colleagues wrote in the study background. “The 6-year expenditures of Blue Cross and Blue Shield enrollees and the 3-year expenditures of patients receiving care through the Veterans Health Administration of the U.S. Department of Veterans Affairs were similar between patients with obesity who underwent bariatric surgery and matched patients with obesity who did not undergo bariatric surgery, which contradicted earlier observational findings that the expenditure reductions among patients who underwent surgery were sufficiently large to fully offset the cost of the surgery itself within 2 to 5 years after surgery.”

In a retrospective cohort study, Smith and colleagues analyzed data from 9,954 veterans with severe obesity identified from VA electronic health records between 2000 and September 2011 (74.2% men; mean age, 52 years). Within the cohort, 2,498 veterans underwent bariatric surgery (surgery cohort). Researchers used sequential stratification to match each patient in the surgery cohort with up to three patients who had not undergone bariatric surgery but were of the same sex, race, diabetes status and VA regional network and were closest in age, BMI and comorbidities (n = 7,456). Regression models were used to estimate expenditures among the surgery and nonsurgery cohorts from 3 years before surgery to 10 years after surgery, excluding expenditures associated with the initial bariatric surgery procedure.

Veterans in the surgery cohort underwent Roux-en-Y gastric bypass (n = 1,842; 73.7%), sleeve gastrectomy (n = 381; 15.3%), adjustable gastric banding (n = 249; 10%), and other procedures (n = 26; 1%).

Operating room surgery 
A cohort of older veterans with obesity who underwent bariatric surgery experienced an initial drop in pharmacy-related costs when compared with matched adults who did not undergo surgery, but overall health care costs remained comparable between groups during 10 years of follow-up.
Source: Adobe Stock

Mean total expenditures for the surgery cohort were $5,093 (95% CI, 4,811-5,391) at 7 to 12 months before surgery, which increased to $7,448 (95% CI, 6,989-7,936) at 6 months after surgery. Postsurgical expenditures fell to $6,692 (95%CI, 6,197-7,226) at 5 years after surgery, followed by a gradual increase to $8,495 (95% CI, 7,609-9,484) at 10 years after surgery. Total expenditures were higher in the surgery cohort vs. the nonsurgery cohort during the 3 years before surgery and in the first 2 years after surgery.

Researchers found that expenditures for the two cohorts converged 5 to 10 years after surgery. Outpatient pharmacy expenditures were lower for the surgery cohort in all years of follow-up; however, the cost reductions were offset by higher inpatient and outpatient nonpharmacy expenditures, according to the researchers.

“Given the evidence that bariatric surgery is associated with long-term, durable weight loss and improvements in long-term survival, the value of bariatric surgery may be primarily in its association with substantial improvements in health and quality of life, not in its potential to achieve cost savings,” the researchers wrote. – by Regina Schaffer

Disclosure: One of the study authors reports owning stock in Amgen.

A cohort of older veterans with obesity who underwent bariatric surgery experienced an initial drop in pharmacy-related costs when compared with matched adults who did not undergo surgery, but overall health care costs remained comparable between groups during 10 years of follow-up, according to findings published in JAMA Surgery.

“It is unclear whether bariatric surgery is associated with lower long-term health care expenditures because, to our knowledge, few randomized clinical trials have examined health care expenditures, and most observational studies have examined expenditures only up to 2 to 3 years after surgery,” Valerie A. Smith, DrPH, of the Center of Innovation to Accelerate Discovery and Practice Transformation at Durham VA Medical Center, North Carolina, and colleagues wrote in the study background. “The 6-year expenditures of Blue Cross and Blue Shield enrollees and the 3-year expenditures of patients receiving care through the Veterans Health Administration of the U.S. Department of Veterans Affairs were similar between patients with obesity who underwent bariatric surgery and matched patients with obesity who did not undergo bariatric surgery, which contradicted earlier observational findings that the expenditure reductions among patients who underwent surgery were sufficiently large to fully offset the cost of the surgery itself within 2 to 5 years after surgery.”

In a retrospective cohort study, Smith and colleagues analyzed data from 9,954 veterans with severe obesity identified from VA electronic health records between 2000 and September 2011 (74.2% men; mean age, 52 years). Within the cohort, 2,498 veterans underwent bariatric surgery (surgery cohort). Researchers used sequential stratification to match each patient in the surgery cohort with up to three patients who had not undergone bariatric surgery but were of the same sex, race, diabetes status and VA regional network and were closest in age, BMI and comorbidities (n = 7,456). Regression models were used to estimate expenditures among the surgery and nonsurgery cohorts from 3 years before surgery to 10 years after surgery, excluding expenditures associated with the initial bariatric surgery procedure.

Veterans in the surgery cohort underwent Roux-en-Y gastric bypass (n = 1,842; 73.7%), sleeve gastrectomy (n = 381; 15.3%), adjustable gastric banding (n = 249; 10%), and other procedures (n = 26; 1%).

Operating room surgery 
A cohort of older veterans with obesity who underwent bariatric surgery experienced an initial drop in pharmacy-related costs when compared with matched adults who did not undergo surgery, but overall health care costs remained comparable between groups during 10 years of follow-up.
Source: Adobe Stock

Mean total expenditures for the surgery cohort were $5,093 (95% CI, 4,811-5,391) at 7 to 12 months before surgery, which increased to $7,448 (95% CI, 6,989-7,936) at 6 months after surgery. Postsurgical expenditures fell to $6,692 (95%CI, 6,197-7,226) at 5 years after surgery, followed by a gradual increase to $8,495 (95% CI, 7,609-9,484) at 10 years after surgery. Total expenditures were higher in the surgery cohort vs. the nonsurgery cohort during the 3 years before surgery and in the first 2 years after surgery.

Researchers found that expenditures for the two cohorts converged 5 to 10 years after surgery. Outpatient pharmacy expenditures were lower for the surgery cohort in all years of follow-up; however, the cost reductions were offset by higher inpatient and outpatient nonpharmacy expenditures, according to the researchers.

“Given the evidence that bariatric surgery is associated with long-term, durable weight loss and improvements in long-term survival, the value of bariatric surgery may be primarily in its association with substantial improvements in health and quality of life, not in its potential to achieve cost savings,” the researchers wrote. – by Regina Schaffer

Disclosure: One of the study authors reports owning stock in Amgen.