Study Suggests Long-term VA Healthcare Costs Similar between Bariatric Surgery Patients and Matched Controls

BACKGROUND:
While bariatric surgery procedures have been associated with improvement in long-term weight and the control of comorbid conditions, the procedures and the management of any surgical complications are costly. To date, it is unknown if increased short-term costs are offset by reductions in long-term costs. This retrospective cohort study sought to determine whether bariatric surgery is associated with differential healthcare expenditures 10 years after the procedure among Veterans with severe obesity. Using VA data, investigators identified 2,498 Veterans with severe obesity who had undergone some type of bariatric surgery between January 2000 and September 2011. Each patient in the surgery cohort was matched with up to three patients with severe obesity who had not undergone bariatric surgery, creating a cohort of 7,456 Veterans similar to those receiving surgery for the comparison of expenditure trends. Potential matches were identified using VA electronic health record data and were based on the patient's sex, diabetes diagnosis, race, VISN, age, diagnostic cost group score, and BMI within six months of surgery.

FINDINGS:

• Total healthcare costs increased immediately following bariatric surgery but were the same as those of Veterans who had not undergone the procedure at 10 years after surgery. Ten-year results suggest that the value of bariatric surgery is associated with improvements in health and not its potential to decrease healthcare costs.
  • Total costs were higher in the surgery cohort than in the non-surgery cohort during the 3 years before surgery and the first 2 years post-surgery. The costs of the two cohorts were similar 5 to 10 years post-surgery.
• Mean total expenditures for the surgery cohort were $5,093 over the 7 to 12 months pre-surgery, which increased to $7,448 at 6 months post-surgery. Healthcare expenditures for those having received bariatric surgery decreased to $6,692 at 5 years post-surgery, followed by a gradual increase to $8,495 at 10 years post-surgery.

IMPLICATIONS:

• The value of funding bariatric surgery may be primarily in its association with substantial improvements in health and quality of life, not in its potential to achieve cost savings.

LIMITATIONS:

• This study used VA data only. Medicare, Medicaid, and private insurance costs were not included.
• Cost estimates represent associations and not the causal effects of bariatric surgery on costs.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (RCS 10-391 and IIR 10-159). Dr. Maciejewski is an HSR&D Research Career Scientist. Drs. Smith, Olsen, Yancy, Weidenbacher, and Maciejewski, and Mr. Berkowitz are part of HSR&D’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC.

Smith V, Arterburn D, Berkowitz T, Olsen M, Livingston E, Yancy W, Weidenbacher H, and Maciejewski M. Association between Bariatric Surgery and Long-Term Health Care Expenditures among Veterans with Severe Obesity. JAMA Surgery. October 30, 2019;epub ahead of print.