The Facts of Obesity and Bariatric Surgery Can Significantly Reduce Medical Costs

Staggering Facts of Obesity and Bariatric Surgery

As we progress into the next decade, the prevalence of obesity has reached epidemic levels. Current trends estimate that 35% of adults in the United States are obese. This trend continues is estimated to reach 50% by 2030! Now more than ever, let’s review the facts of obesity and bariatric surgery

With the associated comorbidities, healthcare costs will continue to skyrocket. In the United States, one in seven healthcare dollars is spent treating diabetes and its complications. Furthermore, over 4100 people every day are newly diagnosed with diabetes. This translates to 1.5 million new diagnoses of diabetes each year!

During the course of the disease, the body becomes less and less sensitive to insulin, and the buildup of byproducts leads to neuropathies, immunosuppression, and organ failure. Of patients who are currently diabetic, roughly 500 patients a day progress to develop a complication of diabetes such as extremity gangrene requiring amputation or end-stage kidney disease.

Individuals experiencing these ailments undergo significant financial burdens in attempts at managing the disease. The average annual medical expense for someone with diabetes in the United States is nearly $17,000! This is nearly 2.3x the amount for someone without any comorbidities.

These effects also extend towards other obesity-related comorbidities such as hypertension, hyperlipidemia, and cardiac disease. On top of the personal costs, there are incredibly steep societal costs. $3.3 billion was lost in productivity from medical leaves of absence, and an additional $26.9 billion was lost due to reduced productivity.

Even more, an additional $50 billion was lost due to disease-related inability to work, and early death. It becomes clear based on these numbers that the problem is staggeringly vast.

Preventative medicine is often the best and cost-effective intervention. Bariatric surgery, as an elective surgery performed to induce a metabolic change, can be considered in this situation a preventative surgery to improve health and reduce complications prior to occurring. The significant personal and financial costs associated with end-stage complications of diabetes, kidney disease, heart disease, and other obesity related comorbidities can be drastically diminished after bariatric surgery.

Much of modern medicine is focused on intensive lifestyle changes and medical interventions. While these certainly do help manage the comorbid conditions associated with obesity, long-term success defined as resolution of the diseases is not seen as frequently. Often even if weight-loss is obtained, it is not maintained.

As the weight bounces back, most of the benefit gained in saved healthcare costs is lost. In the last several years this has been studied extensively. When evaluating patients who have undergone bariatric surgery, however, the healthcare dollars saved were significant and maintained for a long period of time.

Costs of Co-Morbid Conditions

There is significant savings noted regarding personal costs in patients who underwent surgery. A study out of Rush University Medical Center with 210 patients that underwent either Roux-en-Y gastric bypass or sleeve gastrectomy showed that at the 3 month mark, cost reductions were seen in diabetes and hypertensive medications to an average of $80.25 and $53.99.

At the six-month mark, the numbers reduced to $70.25 and 47.06 respectively, in comparison to $224.60 and $71.02 preoperatively. These numbers show that long term benefit can be maintained, and the cost of surgery is more than offset by the savings.

While there are some studies that show that there is an increase in inpatient costs related to surgical complications that balance out the decrease in outpatient costs, these studies did not take into account the decreased costs of diabetes and comorbidity associated hospitalizations associated with end-stage conditions due to constraints of time.

Studies have also shown that there were noted reductions in rate of TIA and incidence of diabetes in obese persons (16% and 63%, respectively) after surgery. Furthermore, with the adoption of early recovery after surgery (ERAS) pathways, most patients feel comfortable enough the day after surgery to continue their recovery at home.

The ERAS pathway is not just an inpatient measure. It involves education weeks prior to surgery, a change in the preoperative diet including a carbohydrate drink the night before surgery, and multi-modal pain medication and specific anesthesia techniques to improve outcomes and decrease pain, nausea, and discomfort.

Along with ERAS, a push to avoid opioid medications for pain has been successful. Opioids, while useful, have an increased risk of pulmonary complications and addiction in the obese population. All of these measures when implemented together have worked incredibly well to decrease, costs, length of inpatient hospitalization after surgery, and improve patient comfort.

Bariatric surgery has been proven to result in the resolution of obesity-related comorbid conditions. It leads to increased quality of life and a decrease in years of life lost.

One of the most common questions I hear from seminars is the personal cost. While the cost of the workup and procedure can sometimes deter referrals and patients from pursuing the process, it should be noted that the cost savings are far higher than the cost of entry.

Only 1% of patients who meet the criteria for referral get referred to a surgeon. For patients with BMI above 35 with comorbidities related to obesity, or patients with BMI above 40, it is an invaluable pathway to improve health and quality of life.

About The Author

Dr. Anirudha Goparaju treats patients who have hernias of the diaphragm, groin, or abdomen, and patients who are morbidly obese and are candidates for bariatric surgery at NYU Langone Long Island Surgical Associates. Patients also visit Dr. Goparaju with biliary disease and colon and appendix pathology including appendicitis, diverticulitis, and colon cancer.

References:

• Banerjee, S., Garrison, L.P., Jr, Flum, D.R. and Arterburn, D.E. (2017), Cost and Health Care Utilization Implications of Bariatric Surgery Versus Intensive Lifestyle and Medical Intervention for Type 2 Diabetes. Obesity, 25: 1499-1508. doi:10.1002/oby.21927
• Smith VA, Arterburn DE, Berkowitz TSZ, et al. Association Between Bariatric Surgery and Long-term Health Care Expenditures Among Veterans With Severe Obesity. JAMA Surg. 2019;154(12):e193732. doi:10.1001/jamasurg.2019.3732
• Bariatric surgery can significantly reduce medical costs, study shows. (2019, June 21). Retrieved from https://www.upi.com/Health_News/2019/06/21/Bariatric-surgery-can-significantly-reduce-medical-costs-study-shows/1351561115283/?ur3=1