Association of Bariatric Surgery and National Medication Use

Abstract

Bariatric surgical procedures are an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric operations have been noted to potentially decrease postoperative healthcare costs, particularly medication use. We performed a longitudinal analysis of 2007-2012 claims data comparing a bariatric surgical cohort with a propensity-matched nonsurgical control group during a 5-year time period. Truven Health Analytics MarketScan Commercial Claims and Encounters Database, with a total enrollment of 56 million covered lives from all insurers and representing all 50 states, was used. An initial sample of 384,343 obese patients was identified, with a total of 5,978 matched 1:1 pairs of obese bariatric surgical patients and nonsurgical control patients designated after matching and propensity score matching procedure. Two thousand seven hundred of those matched pairs had at least 4 years of follow-up after index date. The matched cohorts included 2,700 patients (77.2% female, mean age 47.1 years). During the 4-year follow-up period, bariatric surgical patients had 22.6% lower pharmacy costs compared with nonsurgical control patients (p < 0.001). Mean total pharmacy costs showed a sustained decrease in the surgical group compared with the matched control group ($8,411 vs $9,900; p < 0.001). Medication use in the surgical group declined significantly from 1 year preoperative to 4 years postoperative in contrast to the control group. In the 4-year postoperative period, the numbers of antidiabetic, antihypertensive, and cardiac prescriptions in the surgical patients were reduced by 73.7%, 48.3%, and 48.9%, respectively, compared with the control patients. Total pharmacy use and costs showed a significant and sustained reduction during a 4-year follow-up period among patients undergoing gastric bypass or band operations in comparison with a propensity-matched control group.