Costs and usage of healthcare services before and after open bariatric surgery
Keywords:
Obesity, morbid, Gastric bypass, Health care costs, Morbidity, Bariatric surgeryAbstract
CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals’ comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.
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References
Owens TM. Morbid obesity: the disease and comorbidities. Crit Care Nurs Q. 2003;26(2):162-5.
Schneider BE, Mun EC. Surgical management of morbid obesity. Diabetes Care. 2005;28(2):475-80.
Allison DB, Fontaine KR, Manson JE, Stevens J, Vanltallie TB. Annual deaths attributable to obesity in the United States. JAMA. 1999;282(16):1530-8.
Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2002-2003. Primeiros resultados - Brasil e grandes regiões. Available from: http://www.ibge.gov.br/home/estatistica/populacao/condicaodevida/pof/2002/default.shtm. Accessed in 2011 (Apr 27).
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289(2):187-93.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW Jr. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med. 1999;341(15):1097-105.
Pories WJ. Bariatric surgery: risks and rewards. J Clin Endocrinol Metab. 2008;93(11 Suppl 1):S89-96.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7): 547-59.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741-52.
Christou NV, Look D, Maclean LD. Weight gain after short- and long- limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734-40.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339-50; discussion 350-2.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238-45.
Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998;6(2):97-106.
Brasil. Banco Central do Brasil. Conversão de moedas [Software for automatic exchange rate conversion, from Brazilian Central Bank.] Available from: http://www4.bcb.gov.br/pec/conversao/Resultado. asp?idpai=convmoeda. Accessed in 2011 (Apr 27).
Brasil. Ministério da Fazenda. Receita Federal. Ato Declaratório Executivo Cosit no 26, de 2 de agosto de 2005. Divulga a cotação média do dólar dos Estados Unidos da América no mês de julho do ano-calendário de 2005, para efeito da apuração do ganho de capital na alienação de moeda estrangeira mantida em espécie. DOU de 4.8.2005. Available from: http://www.receita.fazenda.gov.br/legislacao/atosexecutivos/2005/COSIT/ADCosit026.htm. Accessed in 2011 (Apr 27).
Kelles SM, Barreto SM, Guerra HL. Mortality and hospital stay after bariatric surgery in 2,167 patients: influence of the surgeon expertise. Obes Surg. 2009;19(9):1228-35.
Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long- term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416-23; discussion 423-4.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199(4):543-51.
Brasil. Ministério da Saúde. Informações de Saúde. Datasus. Procedimentos hospitalares do SUS - por local de internação - Minas Gerais. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/pimg.def. Accessed in 2011 (Apr 27).
Livingston EH. Hospital costs associated with bariatric procedures in the United States. Am J Surg. 2005;190(5):816-20.
Zingmond DS, McGory ML, Ko CY. Hospitalization before and after gastric bypass surgery. JAMA. 2005;294(15):1918-24.
Encinosa WE, Bernard DM, Chen CC, Steiner CA. Healthcare utilization and outcomes after bariatric surgery. Med Care. 2006;44(8):706-12.
Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002;12(3):350-3.
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621-32; discussion 632-5.
Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909-17.
Vagenas K, Panagiotopoulos S, Kehagias I, et al. Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity. World J Gastroenterol. 2008;14(39):6024-9.
Livingston EH, Langert J. The impact of age and Medicare status on bariatric surgical outcomes. Arch Surg. 2006;141(11):1115-20; discussion 1121.
