PMD22 COST-BENEFIT ANALYSIS OF BARIATRIC SURGERY FROM A PRIVATE AND PUBLIC THIRD-PARTY PAYER PERSPECTIVE IN CHILE

Abstract

Obesity affects one third of the adult population in Chile. Bariatric Surgery (BS) has the potential of improving health status and saving future medical costs through reduced medical care for conditions associated with Obesity. We conducted a Cost-Benefit analysis of BS from the perspective of public (FONASA) and private (ISAPRES) health insurers in Chile. We compared the cost of Bariatric Surgery and Related Costs (BSRC) including surgical complications, reoperations and future abdominoplasties with expected cost savings on BS patients resulting from a reduction in the incidence and prevalence of Diabetes, Hypertension, Cardiovascular events, and female cancers calculated for a cohort of patients over a 10-year time horizon with characteristics similar to those in the Swedish Obese Subjects Study. Data on annual treatment costs of comorbidities where extracted from a national claims database for ISAPRES and from a national costing study for FONASA. Private insurers billing databases with a 5-year follow-up where used to estimate BS costs and incidence and costs of surgical complications, BS reoperations and abdominoplasties in that time frame, with the assumption of equivalent incidence in private and public insurers. 5.1% of cases had surgical complications requiring rehospitalization, 6.6% of patients had a new BS procedure and 5.5% had abdominoplasties. BSRC for ISAPRES and FONASA was US$ 6,218 and US$ 5,889 respectively. The present value of expected savings from improved future health status in patients undergoing BS was estimated to be US$ 1,360 for FONASA and US$ 1,883 for ISAPRES over 10 years. These estimates imply that the expected savings from avoiding obesity complications represent 23% of the cost of BSRC in FONASA and 30% in ISAPRES. Cost savings related to comorbidities in obese patients resulting from BS account for about one-fourth of the cost of BS in FONASA and about one-third in ISAPRES.