A study on the economic impact of bariatric surgery.
OBJECTIVE
To evaluate the private third-party payer return on investment for bariatric surgery the United States.


METHODS
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.
Cremieux
Pierre-Yves
PY
Analysis Group, Inc, 111 Huntington Ave, 10th Fl, Boston, MA 02199, USA. pcremieux@analysisgroup.com
Buchwald
Henry
H
Shikora
Scott A
SA
Ghosh
Arindam
A
Yang
Haixia Elaine
HE
Buessing
Marric
M
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery / Q000191:economics*; D016022:Case-Control Studies; D015897:Comorbidity; D017046:Cost Savings; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000145:classification / Q000706:statistics & numerical data*; D005102:Health Expenditures; D006801:Humans; D007345:Insurance Claim Review; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data* / Q000639:trends; D007449:Investments / Q000191:economics; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D017059:Models, Econometric; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D013673:Technology Assessment, Biomedical; D014481:United States