The impact of bariatric surgery on the Veterans Administration healthcare system: a cost analysis.
BACKGROUND
The economic burden of caring for veterans with clinically severe obesity and its comorbidities is straining the Veterans Administration (VA) healthcare system. The authors determined the cost of Roux-en-Y Gastric Bypass (RYGBP) in the VA's single-payor healthcare system.


METHODS
The records of all 25 patients who underwent RYGBP from May 1999 to October 2001 were reviewed. All obesity-related health-care costs including hospitalizations as well as outpatient visits, medications and home health devices were calculated for 12 months before and after the RYGBP.


RESULTS
Age was 52+/-2 yr and preoperative BMI was 52+/-2 kg/m(2); ASA score was III (21 patients) and II (4 patients). Mean follow-up was 18 months. Total cost of care for these patients preoperatively was $10,778+/-2,460/patient (outpatient visits=$5,476+/-682, hospital admissions=$12,221+/-6,062, and home health devices=$1,383+/-349). Postoperative length of stay was 8+/-0.5 days. Cost of the gastric bypass was $8,976+/-497/pt (OR fixed cost=$1,900/patient + ICU and ward=$7,076+/-497/patient). For the first postoperative year, 6 patients had 12 admissions, but routine outpatient visits were significantly reduced from 55+/-6 to 18+/-2 postoperatively (P<0.001). The cost of all care excluding peri-operative charges for 1 year after gastric bypass was $2,840+/-622/patient (P=0.005 vs preop).


CONCLUSIONS
Operative treatment of clinically severe obesity reduces obesity-related expenditures and utilization of healthcare resources. The cost of undertaking RYGBP at the VA is offset by reduction of health-care costs within the first year after surgery. These data support allocation of resources to support existing bariatric surgery programs throughout the VA system.
Gallagher
Scott F
SF
Department of Surgery, Bay Pines VAMC and Interdisciplinary Obesity Group, University of South Florida College of Medicine, Tampa, FL 33744 USA.
Banasiak
Magdalena
M
Gonzalvo
John P
JP
Paoli
Daniel P
DP
Allwood
Janice
J
Morris
Debra
D
Murr
Michel M
MM
Shapiro
David H
DH
D003365:Costs and Cost Analysis; D005260:Female; D015390:Gastric Bypass / Q000191:economics*; D015276:Health Care Rationing / Q000191:economics; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D040841:Resource Allocation; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics*