The business case for bariatric surgery revisited: a non-randomized case-control study.
OBJECTIVE
Prior studies reporting that bariatric surgery (including laparoscopic adjustable gastric band (LAGB) and [laparoscopic Roux-en-Y] Gastric Bypass (LRYGB)) is cost-saving relied on a comparison sample of those with a morbid obesity (MO) diagnosis code, a high cost group who may not be reflective of those who opt for the procedures. We re-estimate net costs and time to breakeven using an alternative sample that does not rely on this code.


METHODS
Non-randomized case-control study using medical claims data from a commercial database in the USA. LAGB and LRYGB claimants were propensity score matched to two control samples: one restricted to those with a MO diagnosis code and one without this restriction.


RESULTS
When using the MO sample, costs for LAGB and LRYGB are recovered in 1.5 (Confidence Interval [CI]: 1.45 to 1.55) and 2.25 years (CI: 2.07 to 2.43), and 5 year savings are $78,980 (CI: 62,320 to 100,550) for LAGB and $61,420 (CI: 44,710 to 82,870) for LRYGB. Without the MO requirement, time to breakeven for LAGB increases to 5.25 (CI: 4.25 to 10+) years with a 5 year net cost of $690 (CI: 6,800 to 8.400). For LRYGB, time to breakeven exceeds 10 years and 5 year net costs are $18,940 (CI: 10,390 to 26,740).


CONCLUSIONS
The net costs and time to breakeven resulting from bariatric surgery are likely less favorable than has been reported in prior studies, and especially for LRYGB, with a time to breakeven of more than twice the 5.25 year estimate for LAGB.
Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore ; Global Health Institute, Duke University, Durham, North Carolina, United States of America.
Eric A
EA
Finkelstein
Benjamin T
BT
Allaire
Denise
D
Globe
John B
JB
Dixon
D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000191:economics*; D016022:Case-Control Studies; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery; D055815:Young Adult