Bariatric surgery cost-effective for treating obesity

Health insurers can offset the cost of laparoscopic or traditional bariatric surgery as a weight-loss treatment for obese patients within two to four years as a result of savings on other medical costs, according to a study published this month in the American Journal of Managed Care, the Wall Street Journal reports.

For the study, Pierre-Yves Cremieux, a health economist and principal at Analysis Group, and colleagues analyzed health insurance claims data for 2003 through 2005 for 3,651 severely obese patients who underwent either laparoscopic or traditional bariatric surgery. The patients in large part were female, with an average age of 44; more than one-third of the patients had high blood pressure, and many of them had high cholesterol, diabetes and other health problems.

Researchers matched each patient based on age, gender, geography, health status and baseline costs with a patient who did not undergo either of the surgeries. Researchers tracked claims data for the patients who underwent either of the surgeries for six months of pre-surgical examination and care, the procedures themselves, and about 18 months of post-surgical care; tracked claims data for post-surgical care for some patients for as long as five years; and tracked claims data for the matched patients over the same period.

According to the study, health insurers that covered patients who underwent laparoscopic surgery, which has an average cost of $17,000, offset the cost in about 25 months. Health insurers that covered patients who underwent traditional bariatric surgery, which has an average cost of $26,000, offset the cost in about 49 months. Cremieux said, "The most cost-effective treatment for obesity is bariatric surgery," adding, "If you do that, within two to four years, you will get your money back." In addition, he said, "We have identified the break-even point for insurers."

Implications

The study could "increase pressure" on health insurers to cover laparoscopic or traditional bariatric surgery, the Journal reports. Many health insurers do not cover the surgeries, although evidence indicates that the procedures are effective as weight-loss treatments, as well as treatments for diabetes, high blood pressure and sleep apnea. Susan Pisano, a spokesperson for America's Health Insurance Plans, said that health insurers continue to have concerns about the safety and effectiveness of the surgeries. She added, "I don't know if these results would be replicated in other populations."

According to the Journal, some lawmakers and health insurance industry observers likely will question the study because Ethicon Endo-Surgery, the weight-loss surgery device and instruments manufacturing division of Johnson & Johnson, funded the research. However, Crémieux said that Ethicon "has been totally hands off" the study. In addition, Michael Chernew, co-editor in chief of the Journal of Managed Care, said that the study underwent a comprehensive examination by independent reviewers who requested a series of revisions. He added, "I won't deny that I would rather this be funded by some other organization, but there is no bias in the methodology."

Eric Finkelstein -- a health economist who earlier conducted a study that found a 10-year return on investment for bariatric surgery -- questioned the study. In the event that the matched patents had "one really bad outcome, such as [a]heart transplant," it could have significantly changed the results of the study, he said. Finkelstein added that the "return-on-investment" analysis of weight-loss surgery is "misguided," as such analysis is not used to determine the cost-effectiveness of cancer or heart disease treatments (Rundle, Wall Street Journal, 9/8).

An abstract of the study is available online.