The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population
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Our purpose was to assess the cost, quality of life impact, and the cost–utility of bariatric surgery in a managed care population. We studied 221 patients who underwent bariatric surgery between 2001 and 2005. We analyzed medical claims data for all patients and survey data for 122 survey respondents (55% response rate). Patients were generally middle-aged, female, and white. Sixty-four percent underwent open and 33% underwent laparoscopic Roux-en-Y procedures. One year after surgery, mean body mass index fell from 51 to 31 kg/m2 in women and from 59 to 35 kg/m2 in men with substantial improvements in comorbidities. Postsurgical mortality and morbidity were low. Total per member per month costs increased in the 6 months before bariatric surgery, were lower in the 12 months after bariatric surgery, but increased somewhat over the next 12 months. When presurgical quality of life was assessed prospectively, average health utility scores improved by 0.14 one year after surgery. In analyses that took a lifetime time horizon, projected future costs based on age and obesity and discounted costs and health utilities at 3% per year, the cost–utility ratio for bariatric surgery versus no surgery was approximately $1,400 per quality-adjusted life-year gained. In sensitivity analyses, bariatric surgery was more cost-effective in women, non-whites, more obese patients, and when performed laparoscopically. Although not cost-saving, bariatric surgery represents a very good value for money. Its long-term cost effectiveness appears to depend on the natural history and cost of late postsurgical complications and the natural history and cost of untreated morbid obesity.
KeywordsBariatric surgery Cost utility Quality of life
Conflict of interest
The authors declare no conflict of interest.
- 4.NIH Technology Assessment Conference Panel. Methods for voluntary weight loss and control. Ann Intern Med. 1993;119(7 pt 2):764.Google Scholar
- 5.Shekelle PG, Morton SC, Maglione M et al. Pharmacological and surgical treatment of obesity. Evidence Report/Technology Assessment No. 103 (prepared by the Southern California-RAND Evidence-based Practice Center, under Contract No. 290-02-0003). AHRQ Publication No. 04-E028-1. Rockville, MD: Agency for Healthcare Research and Quality, July 2004.Google Scholar
- 7.Centers for Medicare and Medicaid Services. Medicare Coverage Database. Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R). Vol. 2006: US Department of Health and Human Services. Available at: http://www.cms.hhs.gov/mcd/viewdecisionmemo. Accessed December 3, 2008.
- 9.Benko LB. Weighty concerns. Mod Healthc. 2006;36:39.Google Scholar
- 10.Freudenheim M. Hospitals pressured by soaring demand for obesity surgery. The New York Times, 29 August 2003.Google Scholar
- 11.AHRQ study finds weight-loss surgeries quadrupled in five years. Press Release, July 12, 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/press/pr2005/wtlosspr.htm.
- 17.Red Book: Pharmacy’s Fundamental Reference, 2006 Edition. Thomson PDR, Montvale, NJ, 2006.Google Scholar
- 18.EQ-5D. A standardised instrument for use as a measure of health outcome. http://www.euroqol.org/.
- 20.Finkelstein EA, Brown DS. Return on investment for bariatric surgery. AJMC. 2008;14:561–2.Google Scholar
- 22.Table 101. Expectation of Life and Expected Deaths, by Race, Sex, and Age: 2004. U.S. National Center for Health Statistics, Vital Statistics of the United States, annual; and National Vital Statistics Report (NVSR), Vol. 54, No. 14, found at http://www.census.gov/compendia/statab/cats/births_deaths_marriages_divorces/life_expectancy.html.