Original Article

Actual Medical and Pharmacy Costs for Bariatric Surgery: 6-Year Follow-Up

Authors: Valerie H. Myers, PhD, Megan A. McVay, PhD, Claire E. Adams, PhD, Brooke L. Barbera, PhD, Meghan M. Brashear, MPH, William D. Johnson, PhD, Patricia Smith Boyd, BA, Phillip J. Brantley, PhD

Abstract

Objective: To determine the change in total medical expenditures, total pharmacy expenditures, and subcategories of medical and pharmacy expenditures in obese individuals following weight loss surgery (WLS), and to compare these costs with expenditures in obese individuals not receiving WLS.


Methods: Louisiana Office of Group Benefits (OGB), the state-managed health insurer, invited members to be evaluated for insurance-covered WLS. Of 951 obese members who provided written consent to begin the WLS screening process, 40 were selected for surgery. Medical and pharmaceutical claims cost data of the 911 patients who did not have surgery and the 39 individuals who completed surgery were compared over a 2-year presurgical and 6-year postsurgical period.


Results: Total nonpharmacy medical costs were lower for WLS patients compared with non-WLS patients beginning 4 years postsurgery and lasting through 6 years postsurgery. No differences were found between WLS and non-WLS patients in expenditures for most medical subcategories examined, including emergency department, physical and occupational therapy, office visits, and laboratory/pathology; whereas sleep facility and all remaining medical expenditures not represented by a subcategory were lower for WLS patients during some postsurgery years. Total pharmacy costs were lower for WLS participants at 2 and 3 years postsurgery, but these lower costs were not maintained; however, costs remained lower for antidiabetic agents, antihypertensive agents, and dyslipidemic agents through all 6 postsurgery years under study.


Conclusions: The cost of WLS may begin to be recouped within the first 4 years postsurgery with continued effects 6 years postsurgery.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Sjostrom L, Lindroos A, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683–2693.
 
2. Dixon J, O’Brien P, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008; 299: 316–323.
 
3. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122: 248–256.
 
4. Adams T, Gress R, Smith S, et al. Long-term mortality after gastric bypass surgery. N Engl J Med2007; 357: 753–761.
 
5. Finkelstein E, Trogdon J, Cohen J, et al. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff 2009; 28: w822–w831.
 
6. Arterburn D, Maciejewski M, Tsevat J. Impact of morbid obesity on medical expenditures in adults. Int J Obes 2005; 29: 334–339.
 
7. Cawley J, Meyerhoefer C. The Medical Care Costs to Obesity: An Instrumental Variable Approach. Working paper 16467. Cambridge, MA, National Bureau of Economic Research, 2010.
 
8. Congressional Budget Office. How Does Obesity in Adults Affect Spending on Health Care?Washington, DC, Congressional Budget Office, 2010.
 
9. Finkelstein E, Brown D. A cost-benefit simulation model of coverage for bariatric surgery among full-time employees. Am J Manag Care 2005; 11: 641–646.
 
10. Cremieux P, Buchwald H, Shikora S, et al. A study on the economic impact of bariatric surgery. Am J Manag Care 2008; 14: 589–596.
 
11. Klein S, Ghosh A, Cremieux P, et al. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI 35 kg/m2. Obesity 2011; 19: 581–587.
 
12. Finkelstein E, Brown D. Return on investment for bariatric surgery. Am J Manag Care 2008; 14: 561–562.
 
13. Maciejewski ML, Smith VA, Livingston EH, et al. Health care utilization and expenditure changes associated with bariatric surgery. Med Care 2010; 48: 989–998.
 
14. McEwen L, Coelho R, Baumann L, et al. The cost, quality of life impact, and cost-utility of bariatric surgery in a managed care population. Obes Surg 2010; 20: 919–928.
 
15. Agren G, Narbro K, Näslund I, et al. Long-term effects of weight loss on pharmaceutical costs in obese subjects. A report from the SOS intervention study. Int J Obes 2002; 26: 184–192.
 
16. Snow L, Weinstein L, Hannon J, et al. The effect of Roux-en-Y gastric bypass on prescription drug costs. Obes Surg 2004; 14: 1031–1035.
 
17. Nguyen N, Varela J, Sabio A, et al. Reduction in prescription medication costs after laparoscopic gastric bypass. Am Surg 2006; 72: 853–856.
 
18. Agren G, Narbro K, Jonsson E, et al. Cost of in-patient care over 7 years among surgically and conventionally treated obese patients. Obes Res 2002; 10: 1276–1283.
 
19. Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA 2005; 294: 1918–1924.
 
20. Keating C, Dixon J, Moodie M, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care 2009; 32: 567–574.
 
21. Martin LF, Lundberg AP, Juneau F, et al. A description of morbidly obese state employees requesting a bariatric operation. Surgery 2005; 138: 690–700.
22. Myers VH, Adams CE, Barbera BL, et al. Medical and psychosocial outcomes of laparoscopic roux-en-Y gastric bypass: cross-sectional findings at 4-year follow-up. Obes Surg 2012; 22: 230–239.
 
23. Narbro K, Agren G, Jonsson E, et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Intern Med 2002; 162: 2061–2069.
 
24. Finkelstein E, DiBonaventura M, Burgess S, et al. The costs of obesity in the workplace. J Occup Environ Med 2010; 52: 971–976.