Variations in bariatric surgical care pathways: a national costing study on the variability of services and impact on costs

Eleanor Grieve,Sally Stewart,Jennifer Logue,Miranda Trevor,Joanne O'Donnell,Ruth M Mackenzie,Abdulmajid Ali,Jane Munro,Duff Bruce

doi:10.1186/s40608-018-0223-3

Eleanor Grieve, Sally Stewart + Show 7 more

Open Access

https://doi.org/10.1186/s40608-018-0223-3

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Abstract

BackgroundWe undertook a survey of all bariatric centres in Scotland in order to describe current pre- and post-operative care, to estimate their costs and explore differences in financial impact.MethodsA questionnaire was distributed to each health centre. Descriptive statistics were used to present average cost per patient along with 95% confidence intervals, and the range of costs.ResultsResults show nearly a five-fold difference in costs per patient for pre-operative services (range £226 - £1071) and more than a three-fold difference for post-operative services (range £259 - £896).ConclusionsThere is a lack of evidence base and a clear requirement for the evaluation of bariatric surgical services to identify the care pathways pre- and post-surgery which lead to largest improvements in health outcomes and remain cost-effective.

Highlights

We undertook a survey of all bariatric centres in Scotland in order to describe current pre- and postoperative care, to estimate their costs and explore differences in financial impact
Anecdote suggests that bariatric surgery care pathways vary considerably, including access to psychology
To establish pre-operative assessment and post-operative care pathways used in bariatric surgery services in Scotland, a questionnaire was distributed to each health centre (Additional file 1)

Summary

Introduction

We undertook a survey of all bariatric centres in Scotland in order to describe current pre- and postoperative care, to estimate their costs and explore differences in financial impact. Conclusions: There is a lack of evidence base and a clear requirement for the evaluation of bariatric surgical services to identify the care pathways pre- and post-surgery which lead to largest improvements in health outcomes and remain cost-effective. Pre- and post-operative care is a major component of the total cost of bariatric surgery. International bariatric guidance, whilst based on best practice, is not specific on what the optimal model of care is [4] and there is little evidence of whether intensive pre- and post-operative care improves outcomes and is cost-effective compared to less intensive care. We undertook a survey of all bariatric centres in Scotland in

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Conclusion