Abstract
Background
Bariatric surgery (BS) procedures are increasing but few studies have investigated their influence on medical management and costs in France.
Methods
The “Echantillon Généraliste des Beneficiaires” (EGB) is a 1/97 representative sample (n = 520,000 in 2011) of a national claims database covering about 80 % of the population. Adult patients treated for the first time with BS from January 2007 to December 2009 were identified, and a cohort including 350 patients was constituted with a 2-year follow-up before and after this primary procedure date (T). All items of reimbursed medical consumption and comorbidities over this period were identified. A comparison on the consumed resources and costs of BS was performed over time using multivariate models.
Results
The annual per capita reimbursed health expenses evolved from 2633 € (±3124) in year (T − 2) to 3557 € (±3380) in (T − 1), to 4240 € (±3840) in (T + 1) (excluding procedure cost), and to 3755 € (±5037) in (T + 2) with differences according to the type of surgery. In 39 % of patients, the evolution of those costs between (T − 2) and (T + 2) decreased by 5 %. In multivariate models, the significant factors were the presence of diabetes or hypertension medications before the procedure. Most items of medical consumption increased over the period pre- and post-procedure and started to decrease in (T + 2).
Conclusions
Although this series contains mostly gastric bandings, which were less likely to affect comorbidities, the workup for preparing BS was probably an opportunity to benefit from a general clinical assessment which has generated extra short-term medical consumption and expenses began decreasing without allowing return on investment.
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References
Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308:1122–31.
Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10:653–62.
Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.
Basdevant A, Paita M, Rodde-Dunet MH, et al. A nationwide survey on bariatric surgery in France: two years prospective follow-up. Obes Surg. 2007;17:39–44.
Charles MA, Eschwege E, Basdevant A. Monitoring the obesity epidemic in France: the Obepi surveys 1997–2006. Obesity (Silver Spring). 2008;16:2182–6.
Tuppin P, de Roquefeuil L, Weill A, et al. French national health insurance information system and the permanent beneficiaries sample. Rev Epidemiol Sante Publique. 2010;58:286–90.
Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246:1034–9.
Makary MA, Clark JM, Shore AD, et al. Medication utilization and annual health care costs in patients with type 2 diabetes mellitus before and after bariatric surgery. Arch Surg. 2010;145:726–31.
Sampalis JS, Liberman M, Auger S, et al. The impact of weight reduction surgery on health-care costs in morbidly obese patients. Obes Surg. 2004;14:939–47.
Sussenbach SP, Padoin AV, Silva EN, et al. Economic benefits of bariatric surgery. Obes Surg. 2012;22:266–70.
Cremieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manage Care. 2008;14:589–96.
Klein S, Ghosh A, Cremieux PY, et al. Economic impact of the clinical benefits of bariatric surgery in diabetes patients with BMI >/=35 kg/m(2). Obesity (Silver Spring). 2011;19:581–7.
Mullen DM, Marr TJ. Longitudinal cost experience for gastric bypass patients. Surg Obes Relat Dis. 2010;6:243–8.
Myers VH, McVay MA, Adams CE, et al. Actual medical and pharmacy costs for bariatric surgery: 6-year follow-up. South Med J. 2012;105:530–7.
Maciejewski ML, Livingston EH, Smith VA, et al. Health expenditures among high-risk patients after gastric bypass and matched controls. Arch Surg. 2012;147:633–40.
Neovius M, Narbro K, Keating C, et al. Health care use during 20 years following bariatric surgery. JAMA. 2012;308:1132–41.
Weiner JP, Goodwin SM, Chang HY, et al. Impact of bariatric surgery on health care costs of obese persons: a 6-year follow-up of surgical and comparison cohorts using health plan data. JAMA Surg. 2013;148:555–62.
Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.
Kraft K, Mariette C, Sauvanet A, et al. Indications for ambulatory gastrointestinal and endocrine surgery in adults. J Visc Chir. 2011;148:69–74.
Funding
This study was supported by a grant from Johnson & Johnson to Cemka-Eval.
Conflict of Interest
The authors have declared no conflicts of interest.
Statement of Informed Consent
For this administrative anonymous claims database based study, informed consent was not required.
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For this type of study, formal consent is not required.
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Czernichow, S., Moszkowicz, D., Szwarcensztein, K. et al. Impact of Bariatric Surgery on the Medical Management and Costs of Obese Patients in France: an Analysis of a National Representative Claims Database. OBES SURG 25, 986–996 (2015). https://doi.org/10.1007/s11695-014-1488-3
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DOI: https://doi.org/10.1007/s11695-014-1488-3