have to write speech on y insur. companies should cover bariactric surgeries
A study on the economic impact of bariatric surgery.
Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M.Analysis Group, Inc, 111 Huntington Ave, 10th Fl, Boston, MA 02199, USA. [email protected]
OBJECTIVE: To evaluate the private third-party payer return on investment for bariatric surgery the United States. STUDY DESIGN: Morbidly obese patients aged 18 years or older were identified in an employer claims database of more than 5 million beneficiaries (1999-2005) using International Classification of Diseases, Ninth Revision, Clinical Modification code 278.01. Each of 3651 patients who underwent bariatric surgery during this period was matched to a control subject who was morbidly obese and never underwent bariatric surgery. Bariatric surgery patients and controls were matched based on patient demographics, selected comorbidities, and costs. METHODS: Total healthcare costs for bariatric surgery patients and their controls were recorded for 6 months before surgery through the end their continuous enrollment. To account for potential differences in patient characteristics, we calculated the cost differential by estimating a Tobit model. A return on investment was estimated from the resulting coefficients. Costs were inflation adjusted to 2005 US dollars using the Consumer Price Index for Medical Care, and the cost savings were discounted by 3.07%, the month Treasury bill rate during the same period. RESULTS: The mean bariatric surgery investment ranged from approximately $17,000 to $26,000. After controlling for observable patient characteristics, we estimated all costs to have been recouped within 2 years for laparoscopic surgery patients and within 4 years for open surgery patients. CONCLUSIONS: Downstream savings associated with bariatric surgery are estimated to offset the initial costs in 2 to 4 years. Randomized or quasiexperimental studies would be useful to confirm this conclusion, as unobserved characteristics may influence the decision to undergo surgery and cannot be controlled for in this analysis.
PMID: 18778174 [PubMed - indexed for MEDLINE]
From the *Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, Maryland; daggerCenter for Financing, Access, and Cost Trends, AHRQ, Rockville, Maryland; and double daggerSchool of Pharmacy, University of Maryland, Baltimore, Maryland.
OBJECTIVE:: Bariatric surgery is one of the fastest growing hospital procedures, but with a 40% complication rate in 2001. Between 2001 and 2005 bariatric surgeries grew by 113%. Our objective is to examine how 6-month complications improved between 2001 and 2006, using a nationwide, population-based sample. DATA/DESIGN:: We examined insurance claims in 2001-2002 and 2005-2006 for 9582 bariatric surgeries, at 652 hospitals, among a population of 16 million nonelderly people. Outcomes and costs were risk-adjusted using multivariate regression methods with hospital fixed effects. PRINCIPAL FINDINGS:: Between 2001 and 2006, while older and sicker patients underwent the surgery, the 180-day risk-adjusted complication rate declined 21% from 41.7% to 32.8%. Most of the improvement was in the initial hospital stay, where the risk-adjusted inpatient complication rate declined 37%, from 23.6% to 14.8%. Risk-adjusted rates of readmissions with complications declined 31%, from 9.8% to 6.8%. Risk-adjusted hospital days declined from 6 to 3.7 days, and risk-adjusted and inflation-adjusted payments declined 6%.Improvements in complication rates and readmission rates were associated with a within-hospital 30% increase in hospital volume. Volume had no impact on costs. The use of laparoscopy, whi*****reased from 9% to 71%, reduced costs by 12%, while gastric banding decreased costs by 20%. Laparoscopy had no impact on readmissions, but the increase in banding without bypass reduced readmissions. CONCLUSIONS:: Improvements in bariatric outcomes and costs were due to a mix of within-hospital volume increases, a move to a laparoscopic technique, and an increase in banding without bypass.
PMID: 19318997 [PubMed - as supplied by publisher]
