Cost-effectiveness Of Bariatric Surgery Research Articles

The cost of bariatric medical tourism on the Canadian healthcare system

BackgroundMedical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed. MethodsBetween February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return. ResultsConservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD. ConclusionsThe absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment.

Cost-effectiveness of Bariatric Surgery

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.

Role and cost effectiveness of bariatric surgery in T2DM

AbstractInterest in bariatric surgery has gathered pace with wider awareness of its benefits for weight loss and for important weightrelated diseases, especially type 2 diabetes mellitus (T2DM). BS enables many patients with T2DM to achieve normal blood glucose levels and discontinue medication. This has generated lively debate about the role and cost‐effectiveness of BS in treating T2DM and whether BS should be offered more widely. Paradoxically, however, these discussions seldom examine the health service perspective. This article summarises recent evidence and asks whether BS could replace conventional treatment for some people with T2DM. Copyright © 2013 John Wiley & Sons, Ltd.

Bariatric Surgery for the Treatment of Severely Obese Patients in South Korea—Is it Cost Effective?

In South Korea, the number of severely obese patients has increased. An economic study comparing bariatric surgery with nonsurgical interventions has not been published for Asia. This study was conducted to evaluate the cost effectiveness of bariatric surgery as compared to nonsurgical interventions for severe obese Korean people. We used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives. Our target cohort consisted of severe obese people defined as having a body mass index of 30-<40 kg/m(2) in South Korea. The starting age of the cohort was 30 years old, and the cycle length was 1 year. Nonsurgical interventions included a physician visit, exercise, diet, and pharmacotherapy. A discount of 5 % was applied in cost and QALY. The incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to nonsurgery interventions was calculated. The cost-utility analysis study indicated that bariatric surgery had US$1,522 incremental costs and 0.86 incremental QALYs as compared to nonsurgical interventions. Through the base case analysis, ICER was US$1,771/QALY. The sensitivity analyses were performed using a variety of assumptions, and the robustness of the study results was also demonstrated. The study indicated that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people.

Predictors of Attrition in Bariatric Aftercare: A Systematic Review of the Literature

Bariatric surgery results in greater weight loss and maintenance than non-surgical interventions in obese patients. Inadequate adherence to aftercare is associated with poor weight loss and maintenance, poorer control of obesity-related comorbidities, and the development of post-operative complications. This study aims to identify factors influencing failure to attend follow-up visits in the adult post-bariatric surgery patients. A systematic review was undertaken to identify factors associated with attrition from bariatric aftercare in adult (18-65years) obese (BMI > 30) patients. Eight studies published before May 2011 and addressing factors associated with bariatric aftercare attendance were identified. Few consistent findings were evident. Greater pre-surgical weight and greater travel distance to the follow-up centre were more commonly associated with attrition. Conclusions were limited by the very small number of studies, the different types of bariatric surgery studied and the variety of methodologies employed and variables considered. There is a need for research identifying the modifiable attrition risk factors that can be targeted to improve surgical aftercare attendance. This has the potential to facilitate long-term weight loss and maintanence as well as to reduce post-operative complications and costs; thus improving both the effectiveness and the cost-effectiveness of bariatric surgery.

PSU25 Clinical and Cost Effectiveness of Bariatric Surgery for Obese Patients: Economic Evaluation in South Korea

PSU25 Clinical and Cost Effectiveness of Bariatric Surgery for Obese Patients: Economic Evaluation in South Korea

Post-bariatric surgery body contouring in the NHS: A survey of UK bariatric surgeons

Following massive weight loss, patients are left with folds of redundant skin that may cause physical and psychological problems. These problems can be addressed through body contouring procedures such as abdominoplasty and the thigh lift. Despite an exponential rise in the number of bariatric surgery procedures performed in the United Kingdom, there are no national guidelines on the provision of body contouring procedures after massive weight loss. We conducted a survey of UK Bariatric Surgeons to determine the pre-operative counselling that patients receive on this issue, their opinions towards post-bariatric surgery body contouring and current referral patterns to Plastic Surgery. By exploring the relationship between Bariatric and Plastic Surgery, we aimed to identify how the comprehensive treatment of patients undergoing bariatric surgery could be improved. A questionnaire was sent to 86 surgeon members of the British Obesity and Metabolic Surgery Society. Questionnaires were analysed from the 61/86 respondents (71% response rate). 92% of the responding surgeons feel that patients face functional problems relating to skin redundancy after massive weight loss, and a high percentage of patients complain about this problem. However, only 66% of surgeons routinely counsel patients about these problems before they undergo bariatric surgery. 96% of respondents feel that body contouring for these patients should be funded on the NHS in selected cases. However, it is difficult for patients to access consultation with a Plastic Surgeon and there are no explicit guidelines on the criteria that patients must fulfil to undergo body contouring surgery on the NHS. At present, these criteria are locally determined and represent a postcode lottery. The NICE guidelines on obesity recommend that patients undergoing bariatric surgery should have information on, or access to plastic surgery where appropriate, but this standard is not being achieved. National guidelines on post-bariatric body contouring surgery are needed to improve the comprehensive treatment of these patients. The clinical and cost effectiveness of bariatric surgery has been well established. Further studies focussing on the outcome of body contouring after massive weight loss could support this becoming and integral part of the bariatric surgery pathway.

Surgical treatment of type 2 diabetes: the surgeon perspective

Type 2 diabetes mellitus (T2DM) is a major health priority globally, having achieved pandemic status in the twenty-first century. Several gastrointestinal procedures that were primarily designed to treat morbid obesity result in dramatic remission of diabetes. Studies in experimental rodent models and humans have shown that the glycemic benefits of surgery are at least in part weight-independent and extend to non-morbidly obese subjects with T2DM. Bariatric procedures differ in their ability to ameliorate type 2 diabetes, with intestinal bypass procedures being more effective than purely restrictive procedures. Several studies have demonstrated that the benefits of bariatric surgery extend beyond amelioration of hyperglycemia and include improvement in other cardiovascular risk factors such as dyslipidemia and hypertension. The safety and cost-effectiveness of bariatric surgery are also well established by several studies. In this paper, the authors present the surgeon perspective on the management of type 2 diabetes focusing on the efficacy, safety and cost-effectiveness of metabolic surgery. The available evidence warrants the inclusion of metabolic surgery in the treatment algorithm of type 2 diabetes.

Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

Use of bariatric surgery for severe obesity has increased dramatically. To systematically review 1. the clinical efficacy and safety, 2. cost-effectiveness of bariatric surgery, and 3. the association between number of surgeries performed (surgical volume) and outcomes. MEDLINE (from 1950), EMBASE (from 1980), CENTRAL, EconLit, EURON EED, Harvard Center for Risk Analysis, trial registries and HTA websites were searched to January 2011. 1. Randomized controlled trials (RCTs) and 2. cost-utility and cost-minimisation studies comparing a contemporary bariatric surgery (i.e., adjustable gastric banding, Roux-en-Y gastric bypass, sleeve gastrectomy) to another contemporary surgical comparator or a non-surgical treatment or 3. Any study reporting the association between surgical volume and outcome. Outcomes included changes in weight and obesity-related comorbidity, quality of life and mortality, surgical complications, resource utilization, and incremental cost-utility. RCT data evaluating mortality and obesity-related comorbidity endpoints were lacking. A small RCT of 16 patients reported that adjustable gastric banding reduced weight by 27% (p < 0.01) compared to diet-treated controls over 40 weeks. Six small RCTs reported comparisons of commonly used, contemporary procedures. Gastric banding reduced weight to a lower extent than gastric bypass and sleeve gastrectomy and resulted in shorter operating times, fewer serious complications, lower weight loss efficacy, and more frequent reoperations compared to gastric bypass. Sleeve gastrectomy and gastric bypass reduced weight to a similar extent. A 2-year RCT in 50 adolescents reported that gastric banding substantially reduced weight compared to lifestyle modification (35 kg vs. 3 kg; p <0.001). Based on findings of 14 observational studies, higher volume centers and surgeons had lower mortality and complication rates. Surgery resulted in long-term incremental cost-utility ratios of $ <1.000-$40,000 (2009 USD) per quality-adjusted-life-year compared with non-surgical treatment. Contemporary bariatric surgery appears to result in sustained weight reduction with acceptable costs but rigorous, longer-term (≥5 year) data are needed and a paucity of RCT data on mortality and obesity related comorbidity is evident. Procedure-specific variations in efficacy and risks exist and require further study to clarify the specific indications for and advantages of different procedures.

Weighing the Clinical Benefits and Economic Impact of Bariatric Surgery in Morbidly Obese Patients with Diabetes

ABSTRACT Diabetes mellitus imposes a large economic burden on individuals and national healthcare systems worldwide. People with type 2 diabetes incur medical costs 2 to 3 times higher than individuals without diabetes. Treatment of type 2 diabetes with conventional lifestyle modification programs and antihyperglycemic medications often fails to achieve long-term weight loss and adequate glycemic control in obese patients. Bariatric surgery is an intensive and highly effective treatment for obesity. It has considerable accompanying beneficial effects on diabetes and other obesity-related comorbidities. We review the literature and summarize key findings about the clinical benefits and cost-effectiveness of bariatric surgery, as well as its use as a treatment for morbidly obese patients with type 2 diabetes. We update our earlier analysis reporting the return on investment (ROI) associated with bariatric surgery for type 2 diabetes patients with body mass index ≥35kg/m 2 . Clinical benefits of bariatric surgery among type 2 diabetes patients have been established in 1 randomized controlled trial and several observational studies. Maximum weight loss was observed in the first 2 years following surgery and was greatest for patients undergoing biliopancreatic diversion/duodenal switch, followed by laparoscopic gastric bypass (LGBP). It was least for laparoscopic adjustable gastric banding (LAGB). Rates of type 2 diabetes improvement ranged from approximately 75% to 81%. Improvement was often observed before marked weight loss was achieved. The results of the cost-effectiveness review establish that bariatric surgery is cost-effective in treating type 2 diabetes relative to conventional therapy; surgery is both more effective and more expensive than no treatment, falling below the conventional US $50 000 per quality-adjusted life-year threshold. Our updated analysis using an administrative claims database confirms that, on average, cost savings begin to accrue to third-party payers at 3 months after surgery. Surgery costs were fully recovered at 47 months (95% CI 34–61) for laparoscopic surgeries. Among pre-index insulin users, insulin use dropped to 4.6% by month 12 in the laparoscopic Roux-en-Y gastric bypass group, versus 10.5% in the laparoscopic adjustable gastric banding group (p=.005). The literature review and updated results suggest that surgical therapy is clinically more effective and ultimately less expensive than standard therapy for morbidly obese patients with type 2 diabetes.

Safety, Effectiveness, and Cost Effectiveness of Metabolic Surgery in the Treatment of Type 2 Diabetes Mellitus

Remission of type 2 diabetes mellitus with metabolic surgery is a field of active investigation and development. The extraordinary results obtained in diabetic patients with BMI > 35 kg/m2 have led investigators to query if similar results could be achieved in patients with BMI < 35 kg/m2. A few studies have been recently conducted to evaluate the safety, effectiveness, and cost effectiveness of bariatric surgery in diabetic patients with BMI BMI < 35 kg/m2. However, stronger evidence would be required before insurance coverage is extended for bariatric surgery to all type 2 diabetic patients, in addition to those with BMI ≥ 35 kg/m2 for whom eligibility is already established. In addition, the hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery are yet to be determined. This paper will review the evidence about safety, effectiveness, and cost effectiveness of bariatric surgery in type 2 diabetes mellitus remission and the potential socioeconomic impact of offering bariatric surgery to diabetic patients with BMI BMI < 35 kg/m2.

Cost-Effectiveness of Bariatric Surgery Assessed

Cost-Effectiveness of Bariatric Surgery Assessed

Bariatric Surgery in the KP Northwest Region: Optimizing Outcomes by Using a Multidisciplinary Program

Although bariatric surgery can be an appropriate treatment option for extremely obese patients, uncertainty exists as to how to optimize treatment outcomes. This article describes a coordinated multidisciplinary program designed to educate and behaviorally prepare patients for bariatric surgery and to support long-term behavioral change.Key aspects of our program include adequate preoperative obesity-related assessment, including nutritional, psychosocial, and physical assessment; emphasis on preoperative behavior change; changing the inpatient surgical treatment care path to decrease the length of hospital stay; and providing long-term management by using enhanced clinical decision support that includes Intranet-based practice resources embedded in the electronic medical record. Self-care is facilitated through group classes and support groups.A multidisciplinary bariatric program optimizes short- and long-term postoperative success and maximizes the safety and cost-effectiveness of bariatric surgery.

The metabolic syndrome: Effects of a pronounced weight loss induced by bariatric surgery

The prevalence of obesity is rising worldwide dramatically, affecting up to 50 percent of the population. The epidemic of obesity leads to a marked increase in the metabolic syndrome, a cluster of cardiovascular risk factors characterized by visceral obesity, insulin resistance, low HDL-Cholesterol, hypertriglyceridemia, and a subclinical proinflammatory state. In the last years, the NCEP and the WHO highlighted and defined the key features of the metabolic syndrome to facilitate the clinical diagnosis and preventive interventions. The conservative therapy of obesity and the metabolic syndrome by life style intervention and pharmacological interventions leads only to moderate weight loss with inconstant long-term success. Intervention by bariatric surgery can serve as a model for the metabolic effects of permanent weight loss. In several studies the pronounced weight loss induced a reduction of almost all components of the metabolic syndrome, including glucose and lipid status and is followed by an improvement in the quality of life. Recent research suggested a decrease in mortality rate in addition to cost effectiveness of bariatric surgery.

The cost-effectiveness of bariatric surgery.

The purpose of the study was to estimate the cost-effectiveness of gastric bypass in the treatment of severe obesity (body mass index > 40). A deterministic decision analysis that compared the lifetime expected costs and outcomes between open gastric bypass and no treatment of severe obesity from the payer perspective was performed. Men and women between the ages of 35 and 55 yr, with body mass index between 40 and 50 kg/m(2), who did not have cardiac disease and who failed conservative treatment, including pharmacotherapy, were included. Cost-effectiveness ratio of the base case conditions was made with parameter estimates from the literature and expert discussion and expressed as cost per quality-adjusted life-years (QALY). One- and two-way sensitivity analyses were performed on selected variables. Gastric bypass was not cost-saving, because the reduction in lifetime medical costs was less than the cost of treatment in any subgroup. The base case cost-effectiveness ratios ranged from 5,400 US dollars to 16,100 US dollars for women and from 10,700 US dollars to 35,600 US dollars per QALY for men. Sensitivity analysis demonstrated that in older, less obese men, the cost effectiveness ratio was responsive to the amount of weight lost, obesity-related quality of life, and complication rates. Parameter variation did not significantly affect cost-effectiveness ratios in the remaining patients. The authors concluded that gastric bypass is a cost-effective alternative to no treatment in the severely obese, at less than 50,000 US dollars per QALY.

The cost-effectiveness of bariatric surgery: Craig BM, Tseng DS. Cost-Effectiveness of Gastric Bypass for Severe Obesity, Am J Intern Med 2002;113:491–8

The purpose of the study was to estimate the cost-effectiveness of gastric bypass in the treatment of severe obesity (body mass index > 40). A deterministic decision analysis that compared the lifetime expected costs and outcomes between open gastric bypass and no treatment of severe obesity from the payer perspective was performed. Men and women between the ages of 35 and 55 yr, with body mass index between 40 and 50 kg/m 2, who did not have cardiac disease and who failed conservative treatment, including pharmacotherapy, were included. Cost-effectiveness ratio of the base case conditions was made with parameter estimates from the literature and expert discussion and expressed as cost per quality-adjusted life-years (QALY). One- and two-way sensitivity analyses were performed on selected variables. Gastric bypass was not cost-saving, because the reduction in lifetime medical costs was less than the cost of treatment in any subgroup. The base case cost-effectiveness ratios ranged from $5,400 to $16,100 for women and from $10,700 to $35,600 per QALY for men. Sensitivity analysis demonstrated that in older, less obese men, the cost effectiveness ratio was responsive to the amount of weight lost, obesity-related quality of life, and complication rates. Parameter variation did not significantly affect cost-effectiveness ratios in the remaining patients. The authors concluded that gastric bypass is a cost-effective alternative to no treatment in the severely obese, at less than $50,000 per QALY.