Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1022 — Long-term Cost of Bariatric Surgery for Veterans

Lead/Presenter: Matthew Maciejewski, COIN - Durham
All Authors: Maciejewski ML (Durham COIN) Olsen MK (Durham COIN) Arterburn DE (Group Health Research Institute) Livingston EH (Dallas VA, JAMA) Yancy WS (Durham COIN) Weidenbacher HJ (Durham COIN) Smith VA (Durham COIN)

Objectives:
Bariatric surgery provides substantial health benefits for patients with severe obesity, but it is not known if these health benefits result in in fewer health expenditures. We compared 5-year health expenditures of veterans who did and did not undergo bariatric surgery.

Methods:
In a retrospective cohort study, veterans (74% male) were identified who underwent bariatric surgery in Veterans Administration (VA) bariatric centers from 2000-2011. Using sequential stratification, surgical patients were matched with up to three nonsurgical patients of the same gender, race, diabetes status, VA regional network, age, body mass index (BMI), and comorbidity measure. Differences from baseline in VA expenditures and the probability of inpatient admission between 2,500 bariatric patients and 7,462 non-surgical matches over five years were estimated in regression models.

Results:
Adjusted total expenditures were higher for surgical patients than nonsurgical matches prior to surgery and remained so (difference-in-difference estimate = $2,628; 95% confidence interval (CI): $1,933 to $3,226) in the 6 months after surgery, but dropped noticeably 7-12 months ($79; 95% CI -$478 to $631) after surgery. Both groups had similar trends for outpatient expenditures, but pharmacy expenditures were less for surgical patients throughout the post-surgical period (-$179; 95% CI: -$225, -$129 six months after surgery to -$318; 95% CI: -$368, -$267 55-60 months after surgery). The probability of inpatient admission was greatly increased following the bariatric procedure, then declined and converged to become similar at 5 years after surgery.

Implications:
In a cohort of predominantly older, male Veterans with severe obesity studies for five years following surgery, VA health care expenditures were no different than matched Veterans who did not undergo bariatric surgery.

Impacts:
The significant improvements in weight, obesity-related comorbidities and long-term survival do not appear to reduce health expenditures for most Veterans undergoing bariatric surgery.