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The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population

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Abstract

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.

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References

  1. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.

    Article  CAS  PubMed  Google Scholar 

  2. Ahroni JH, Montgomery KF, Watkins BM. Laparoscopic adjustable gastric banding: weight loss, co-morbidities, medication usage and quality of life at one year. Obes Surg. 2005;15:641–7.

    Article  PubMed  Google Scholar 

  3. Hensrud DD, Klein S. Extreme obesity: a new medical crisis in the United States. Mayo Clin Proc. 2006;81:S5–S10.

    PubMed  Google Scholar 

  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.

  6. Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    PubMed  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.

  8. Sjöström L, Narbro K, Sjöström CD, et al. Swedish obese subjects study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  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.

  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.

  12. Ackroyd R, Mouiel J, Chevallier JM, et al. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16:1488–503.

    Article  PubMed  Google Scholar 

  13. Salem L, Devlin A, Sullivan SD, et al. A cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding and non-surgical weight loss. Surg Obes Relat Dis. 2008;4:26–32.

    Article  PubMed  Google Scholar 

  14. Ikramuddin S, Klingman D, Swan T, et al. Cost-effectiveness of Roux-en-Y gastric bypass in type diabetes patients. Am J Manag Care. 2009;15:607–15.

    PubMed  Google Scholar 

  15. Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diab Care. 2009;32:567–74.

    Article  Google Scholar 

  16. Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes. Diab Care. 2009;32:580–4.

    Article  Google Scholar 

  17. Red Book: Pharmacy’s Fundamental Reference, 2006 Edition. Thomson PDR, Montvale, NJ, 2006.

  18. EQ-5D. A standardised instrument for use as a measure of health outcome. http://www.euroqol.org/.

  19. Shaw JW, Johnson JA, Coons SJ. US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care. 2005;43:203–20.

    Article  PubMed  Google Scholar 

  20. Finkelstein EA, Brown DS. Return on investment for bariatric surgery. AJMC. 2008;14:561–2.

    Google Scholar 

  21. van Baal PHM, Polder JJ, de Wit GA, et al. Lifetime medical costs of obesity: prevention no cure for increasing health expenditure. PLoS Med. 2008;5:0242–9.

    Article  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.

  23. Flegal KM, Graubard BI, Williamson DF, et al. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293:1861–7.

    Article  CAS  PubMed  Google Scholar 

  24. van Mastrigt GAPG, van Dielen FMH, Severens JL, et al. One-year cost-effectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus lap-band. Obes Surg. 2006;16:75–84.

    Article  PubMed  Google Scholar 

  25. Sach TH, Barton GR, Doherty M, et al. The relationship between body mass index and health-related quality of life: comparing the EQ-5D, EuroQoL VAS and SF-6D. Int J Obes. 2007;31:189–96.

    Article  CAS  Google Scholar 

  26. Potteiger CE, Paragi PR, Inverso NA, et al. Bariatric surgery: shedding the monetary weight of prescription costs in the managed care arena. Obes Surg. 2004;14:725–30.

    Article  PubMed  Google Scholar 

  27. Snow LL, Weinstein LS, Hannon JK, et al. The effect of Roux-en-Y gastric bypass on prescription drug costs. Obes Surg. 2004;14:1031–5.

    Article  PubMed  Google Scholar 

  28. Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–8.

    Article  PubMed  Google Scholar 

  29. Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes. 2003;27:1167–77.

    Article  CAS  Google Scholar 

  30. Crémieux PY, Buchwald H, Shikora SA, et al. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14:589–96.

    PubMed  Google Scholar 

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Health System, 1500 E. Medical Center Dr. 3920 Taubman Center, SPC 5354, Ann Arbor, MI, 48109-5354, USA

    Laura N. McEwen, Renuka B. Coelho, Lauren M. Baumann, Dori Bilik & William H. Herman

  2. M-CARE, Ann Arbor, MI, USA

    Betsy Nota-Kirby & William H. Herman

  3. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

    William H. Herman

Authors
  1. Laura N. McEwen
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  2. Renuka B. Coelho
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  3. Lauren M. Baumann
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  4. Dori Bilik
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  5. Betsy Nota-Kirby
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  6. William H. Herman
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Correspondence to William H. Herman.

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McEwen, L.N., Coelho, R.B., Baumann, L.M. et al. The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population. OBES SURG 20, 919–928 (2010). https://doi.org/10.1007/s11695-010-0169-0

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  • DOI: https://doi.org/10.1007/s11695-010-0169-0

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