title: Direct and indirect costs and potential cost savings of laparoscopic adjustable gastric banding among obese patients with diabetes.
abstract: OBJECTIVE
  To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account.
  
  
  METHODS
  Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature.
  
  
  RESULTS
  Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from $26570 (±$9000) to $34160 (±$10 380) when indirect costs are included.
  
  
  CONCLUSIONS
  This study presented a novel approach for incorporating indirect costs into cost-benefit analyses. Application to gastric banding revealed that inclusion of indirect costs improves the financial outlook for the procedure.
authors.affiliation: Health Services and Systems Research Program, Duke-NUS Graduate Medical School, Singapore, Singapore. eric.finkelstein@duke-nus.edu.sg
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Allaire
authors.forename: Marco DaCosta
authors.initials: MD
authors.lastname: DiBonaventura
authors.forename: Somali M
authors.initials: SM
authors.lastname: Burgess
mesh_terms: D000041:Absenteeism; D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics*; D004526:Efficiency; D005260:Female; D015391:Gastroplasty / Q000191:economics*; D005102:Health Expenditures; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D009765:Obesity / Q000150:complications / Q000191:economics* / Q000601:surgery