Bariatric Surgery Cuts Healthcare Dollars With Minimal Impact on Premiums

By Megan Brooks

November 10, 2015

NEW YORK (Reuters Health) - Morbidly obese patients who had gastric bypass surgery cut their healthcare costs by close to 40% after four years, and the savings were double that if they also had type 2 diabetes before the surgery.

The key drivers in cost savings were related to fewer hospital admissions and clinic visits, and a reduction in the use of prescription drugs for diabetes, hypertension, and heart disease.

"Costs were higher across the board for patients who did not have bariatric surgery showing there is an even higher cost to not treating obesity, in dollars as this study shows and in longevity and quality of life, as many other studies have shown," study co-author Dr. John M. Morton, chief of Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine and president of the American Society for Metabolic & Bariatric Surgery (ASMBS), said in a news release.

The study was presented November 4 at ObesityWeek 2015, hosted by the ASMBS and The Obesity Society (TOS).

This study is "fairly unique in that it is representative of all 50 states and multiple health plans. The data that have been presented in the past often looked at a single payer," Dr. Morton noted in an interview with Reuters Health.

"We had a matched cohort and those obese patients with medical problems have continued rise in cost and we can actually bend the cost curve when it comes to obese patients with bariatric surgery. That cost savings is even more accentuated in when it comes to diabetic patients," Dr. Morton said.

Using the Truven Health Analytics Commercial Claims (MarketScan) database, which has insurance claims for at least 15 million people, the research team identified 823 laparoscopic gastric bypass patients. These patients were propensity matched to 786 non-surgical patients based on age, sex and geographic region, as well as comorbid conditions (diabetes, hypertension, hyperlipidemia and severe obesity) one year before surgery.

All surgeries took place in 2008 and all patients had continuous health insurance coverage for the study period (2004 to 2012).

On average, gastric bypass surgery cost $25,238.

In each of the four years after the surgery healthcare costs dropped by 12%, 28%, 37% and 35%, respectively, the researchers report. For patients with diabetes, costs were 23% lower in the first year after surgery, and continued to drop over the next three years by 49%, 61% and 69%, respectively.

Related research presented at the conference finds that bariatric surgery has minimal impact on insurance premiums under the Affordable Care Act, yet many states still refuse to cover it.

Dr. Wayne English, of Vanderbilt University Medical Center in Nashville, Tennessee and colleagues examined plans in Oklahoma, Oregon and Virginia, states where a portion of the plans cover bariatric surgery.

They found that insurance premiums were generally higher with a surgery benefit, but not by much. In Oregon and Oklahoma, the difference in premiums was about $24.67 and $29.33, respectively. In Virginia, monthly premiums were $14 lower.

"This study shows it's not really a cost issue as to why bariatric surgery isn't covered," Dr. English said in a conference statement. "It may be an issue of false notions about the true costs of bariatric surgery or it may be discrimination. Either way, poor policy is affecting millions of people every day, in many states. It shouldn't matter where you live as to whether or not you have access to bariatric surgery. There is great inequality throughout state health exchanges operating under the Affordable Care Act," he added.

Dr. Morton, who wasn't involved in this study, told Reuters Health, "quite a few states - 27 in total - don't provide coverage for bariatric surgery. The states that don't provide coverage are the ones that need it the most, the states in the Deep South. And one of the reasons often cited is cost. I think we are all aware that bariatric surgery is safe, effective and enduring and a needed therapy for patients. The big question is why are these states still excluding it. In terms of cost, what this study demonstrates is that it's a very minimal additional cost."

Dr. Morton also noted that the ASMBS along with other societies in the Obesity Care Continuum have filed a complaint with the U.S. Department of Health and Human Services (HHS) Office of Civil Rights charging that the failure of those states to cover bariatric surgery is "discriminatory" on three grounds.

"One is the prevalence of coverage that exists in private insurers because it is routinely covered by private insurers; two, there is a gender disparity issue because about 80% of patients who undergo bariatric surgery are women; and the last one is around disability and ethnic minority status, because ethnic minorities have the highest risk for obesity and we know that obesity has been declared a disease and as such the Affordable Care Act is not supposed to discriminate against preexisting conditions," he explained.