Cost-effectiveness of Bariatric Surgery

Abstract

Bariatric surgery is probably more efficacious than medical or lifestyle intervention for long-term weight loss and remission of diabetes. The ability of bariatric surgery to reduce expenditures sufficiently to achieve cost savings remains hotly debated, and in 2 early studies, it appeared cost-saving over a relatively short period of time.1,2 More recent studies,3,4 including an analysis of 29 820 BlueCross BlueShield enrollees published in the June issue of JAMA Surgery,5 show no evidence of cost savings. These results are consistent with prior cost-effectiveness evaluations6,7 that demonstrated cost-effectiveness—but not cost savings—for bariatric procedures compared with usual medical care or intensive lifestyle interventions. Still, a critical policy question remains unanswered: does bariatric surgery need to be cost-effective (ie, more effective but more costly than usual care), or does it need to achieve the higher standard of cost savings (ie, more effective and less costly than usual care) to justify broader insurance coverage? Because bariatric surgery is so expensive, it is unlikely to achieve a cost-saving threshold for most eligible patients. Roux-en-Y gastric bypass (RYGB) costs $25 000 to $30 000 for the surgical admission (including the cost of the procedure and immediate preoperative, intraoperative, and postoperative services), and laparoscopic adjustable gastric banding (LAGB) costs $15 000 to $20 000.5 Annual health care costs for patients with a body mass index (BMI) of 35 or greater are $3000 to $10 000 per year.4,5 Even if total expenditures are reduced 50% after surgery, it may take up to 20 years to achieve cost neutrality. There is a need to identify whether certain bariatric procedures or patient subgroups have greater potential for health improvements and cost savings to inform insurance coverage decisions about bariatric procedures.