Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients.

Abstract

Sir: We read with interest the article by Poyatos entitled “Post–Bariatric Surgery Body Contouring Treatment in the Public Health System: Cost Study and Perception by Patients” published in the September 2014 issue of Plastic and Reconstructive Surgery.1 Because of the high prevalence of obesity, there is a growing demand for bariatric surgery worldwide.2 The indications for bariatric surgery should be viewed in terms of individual patient benefit without anticipating that there will be cost savings to a health care system by offering this treatment. A recent meta-analysis showed that remission of type 2 diabetes occurs in approximately 77 percent of patients and resolves or improves in 85 percent. Dyslipidemia also improves or resolves in 70 to 95 percent of surgically treated patients, as does hypertension in 87 to 95 percent. Surgery also lowered cardiovascular event rates by 43 percent, cancer rates by 33 percent, and overall mortality by 30 percent.3 Health care cost assessment based on claims paid by BlueCross BlueShield for a period up to 6 years postoperatively for almost 30,000 patients who had undergone bariatric surgery failed to demonstrate a cost benefit for weight loss surgery compared with a comparison group of patients who did not undergo surgery but who had similar obesity-related diagnoses. Likewise, cost-effectiveness analysis of data from the U.S. Department of Veterans Affairs did not show a cost benefit for bariatric surgery.4 The time horizon that is relevant for determining the financial case of any intervention can vary widely among payers in the United States. Given the significant turnover in commercially insured populations, early cost reductions are perhaps more important for payers such as BlueCross BlueShield to demonstrate a compelling business case for bariatric surgery. Payers such as Medicare or the Veterans Health Administration can accept longer time horizons to achieve health care cost reductions because they are typically responsible for enrollees over many years.3 It is disappointing that reduced use of health care money cannot be demonstrated in the early years following bariatric surgical procedures, because this economy could pay for the expenses of the plastic surgery. Post–bariatric surgery body contouring treatment is often regarded as cosmetic and therefore of low priority, which means funding is either unavailable or subject to various criteria. Bariatric surgery patients who desire body-contouring surgery perceive cost as a major barrier.5 We propose that post–bariatric surgery patients should have easier access to the plastic surgery procedures more in keeping with the pathway followed by breast cancer patients who are automatically funded for their oncoplastic procedures. For instance, some hospitals provide free health care to people with household incomes up to three times the federal poverty level. Plastic surgery grants help those who cannot afford surgery by funding all or part of the treatment costs. Postbariatric plastic surgery may be covered for some health insurance, and if it is not covered, there is a chance that the patient could get it added to his or her plan. If none of the above applies, the bariatric surgeons should advise their patients to save to have the plastic surgery procedures performed privately. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. This study has not received any supporting funds. Denis S. Valente, M.D. Alexandre V. Padoin, Ph.D. Obesity and Metabolic Syndrome Center Pontifical Catholic University of Rio Grande do Sul Porto Alegre, Brazil