Bariatric Surgery Cuts Costs for Diabetes, Cardiac Drugs

Marlene Busko

November 06, 2014

BOSTON — A new study based on national insurance claims in the United States has found that obese patients who had contemporary bariatric surgery went on to use fewer drugs for conditions such as type 2 diabetes, thus lowering healthcare costs.

Specifically, costs for prescription medications among 2700 patients who underwent laparoscopic gastric banding or bypass surgery were $8411 in the 4 years following the operation vs $9900 for 2700 matched patients who did not have this surgery — a saving of 22.4%.

The surgical patients used significantly fewer prescription drugs for diabetes, hypertension, and heart disease, Dr John M Morton (chief of bariatric and minimally invasive surgery, Stanford University School of Medicine, California), who presented the research, told attendees here at Obesity Week 2014.

The findings have important cost implications for healthcare policy makers. They also shows that bariatric surgery improves patients' quality of life, since "there's no doubt that when patients are taking fewer meds, their satisfaction is going to go up," Dr Morton noted.

However, in response to a question from the audience, Dr Morton conceded that the study did not look at the overall costs of hospitalization for the surgery vs long-term drug-cost savings. Bariatric-surgery costs can range from $17,000 to $30,000, depending on surgical method and geography, according to the American Society for Metabolic and Bariatric Surgery (ASMBS).

Assigned discussant and past president of the ASMBS, Dr Robin Blackstone (Scottsdale Healthcare Bariatric Center, Arizona) said the new paper is timely.

"As the baby boomers are aging and we accumulate more weight, the number of prescriptions we are having to pay for out of our own pockets is going to go way up, and we are all hearing this every day from our patients, so your paper is extremely relevant," she told Dr Morton.

Study Looks at Contemporary Laparoscopic Bariatric Techniques

Dr Morton said the objective of his study "was to look specifically [and only] at pharmacy cost, because we thought it was most representative of the chronic illness" that these patients have.

He noted that research by Dr Jonathan P Weiner and colleagues published in JAMA last year reported that healthcare costs in obese patients who had bariatric surgery were not lower than those of matched patients who did not have surgery.

However, that study was based on claims made by patients in only seven states who were covered by Blue Cross insurance, and this was during 2002 to 2008, before the widespread use of laparoscopic bariatric techniques.

Dr Morton and colleagues used data from the Truven Health Analytics MarketScan database — which consists of insurance claims from 56 million people in 50 states who are covered by multiple insurers — and identified 2700 patients who had laparoscopic bariatric surgery during 2008.

The patients were propensity-matched with an equal number of patients with a similar body mass index (BMI), health status, insurance plan, and address. However, the patients who underwent bariatric surgery had a higher rate of heart disease, acid reflux, and sleep apnea.

All patients were continuously covered by their insurance for the study period: a year before surgery until 4 years afterward.

In the year prior to surgery, costs of prescription medications were $3098 for patients who went on to have surgery, whereas costs for the control patients were $2303.

For the following year, prescription drug costs were similar in both groups: $2209 for the surgery patients and $2407 for the control group.

Dramatic Reduction in Prescriptions Following Operation

However, during the 4 years after surgery, prescription drug use declined in the surgery patients, while it rose in the others.

Notably, the percentage of patients who used medications for diabetes, hypertension, and cardiac disease dropped by 13.3%, 6.9%, and 1.3%, respectively, in the surgery group.

Meanwhile the percentage of patients who used medications for diabetes, hypertension, and heart disease increased by 7.6%, 10.9%, and 12.4%, respectively, in the control group.

The number of prescriptions for antidiabetic medications was 80% lower and the number of antihypertensive medications and cardiac medications about 50% lower in the surgery patients vs the control patients.

These medication-cost savings would probably be maintained beyond 4 years, Dr. Morton speculated, but this remains to be confirmed.

Dr Morton is a consultant for Covidien and is a speaker for Ethicon. Dr Blackstone is a consultant for Johnson & Johnson and was a principal investigator for an Enteromedics research study.

Obesity Week 2014: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting; November 4, 2014; Boston, MA. Abstract A103.

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