title: Impact of bariatric surgery on the medical management and costs of obese patients in France: an analysis of a national representative claims database.
abstract: BACKGROUND
  Bariatric surgery (BS) procedures are increasing but few studies have investigated their influence on medical management and costs in France.
  
  
  METHODS
  The "Echantillon Généraliste des Beneficiaires" (EGB) is a 1/97 representative sample (n = 520,000 in 2011) of a national claims database covering about 80 % of the population. Adult patients treated for the first time with BS from January 2007 to December 2009 were identified, and a cohort including 350 patients was constituted with a 2-year follow-up before and after this primary procedure date (T). All items of reimbursed medical consumption and comorbidities over this period were identified. A comparison on the consumed resources and costs of BS was performed over time using multivariate models.
  
  
  RESULTS
  The annual per capita reimbursed health expenses evolved from 2633 <euro> (±3124) in year (T - 2) to 3557 <euro> (±3380) in (T - 1), to 4240 <euro> (±3840) in (T + 1) (excluding procedure cost), and to 3755 <euro> (±5037) in (T + 2) with differences according to the type of surgery. In 39 % of patients, the evolution of those costs between (T - 2) and (T + 2) decreased by 5 %. In multivariate models, the significant factors were the presence of diabetes or hypertension medications before the procedure. Most items of medical consumption increased over the period pre- and post-procedure and started to decrease in (T + 2).
  
  
  CONCLUSIONS
  Although this series contains mostly gastric bandings, which were less likely to affect comorbidities, the workup for preparing BS was probably an opportunity to benefit from a general clinical assessment which has generated extra short-term medical consumption and expenses began decreasing without allowing return on investment.
authors.affiliation: INSERM UMS 011, Villejuif, France, sebastien.czernichow@apr.aphp.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Czernichow
authors.forename: David
authors.initials: D
authors.lastname: Moszkowicz
authors.forename: Karine
authors.initials: K
authors.lastname: Szwarcensztein
authors.forename: Corinne
authors.initials: C
authors.lastname: Emery
authors.forename: Antoine
authors.initials: A
authors.lastname: Lafuma
authors.forename: Julie
authors.initials: J
authors.lastname: Gourmelen
authors.forename: Francis
authors.initials: F
authors.lastname: Fagnani
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000191:economics; D016208:Databases, Factual; D005260:Female; D005602:France; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000601:surgery* / Q000628:therapy