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Auf der Maur I, Gero D, Kampmann G, Prediger T, Schopf S, Peters J, Widmer J, Deerberg-Wittram J, Köhler-Hohmann C, Bueter M, Thalheimer A. [Healthcare cost reimbursement without application-Experiences of a German bariatric service]. CHIRURGIE (HEIDELBERG, GERMANY) 2022; 93:1082-1088. [PMID: 35904583 PMCID: PMC9592636 DOI: 10.1007/s00104-022-01690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Only a small proportion of patients with morbid obesity in Germany have access to the currently most effective treatment, bariatric surgery. A major reason for this is the restrictive attitude of health insurance companies regarding the reimbursement of costs. OBJECTIVE To record the postoperative rate of cost coverage by health insurance companies without the currently common preoperative application for morbidly obese patients who received a guideline-indicated bariatric surgery. METHODS The process of postoperative reimbursement was evaluated through a prospective database over a 2-year period. Cases of primary reimbursement were correlated with respect to age, BMI, comorbidities and membership of a specific health insurance company. Rejected coverage cases were followed up for further advocacy and social court process. RESULTS A total of 188 patients underwent bariatric surgery as indicated in the guidelines without prior application. Primary cost coverage was achieved in 76.6% (n = 144). There was no correlation with BMI, comorbidities or health insurance affiliation. Patients over 40 years of age were significantly more likely to be covered for costs. For patients without postoperative cost coverage, an out of court settlement was reached in 7 cases, 8 cases were heard by the social courts and 29 cases were still being processed by lawyers. CONCLUSION Despite the relatively high rate of primary cost coverage, this analysis also shows the restrictive attitude of the health insurance companies regarding bariatric surgery with corresponding economic pressure on the service providers. The consistent implementation of application-free surgery seems necessary to increase the political pressure on health insurers and social courts.
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Affiliation(s)
- Isabel Auf der Maur
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | - Daniel Gero
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Gesa Kampmann
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Tobias Prediger
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Stefan Schopf
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Jutta Peters
- Allgemein‑, Viszeral‑, Endokrine und Unfallchirurgie, RoMed Klinik Bad Aibling, Bad Aibling, Deutschland
| | - Jeannette Widmer
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
| | | | - Christel Köhler-Hohmann
- arztundklinikrecht.de/Dr. iur. Christel Köhler-Hohmann, Rechtsanwältin - Fachanwältin für Medizinrecht, Gilching bei München, Deutschland
| | - M Bueter
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz
| | - Andreas Thalheimer
- Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Zürich, Schweiz.
- Department Chirurgie, Spital Männedorf, Männedorf, Schweiz.
- University Hospital Zurich: UniversitatsSpital Zurich, Zürich, Schweiz.
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Borisenko O, Mann O, Duprée A. Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling. BMC Surg 2017; 17:87. [PMID: 28774333 PMCID: PMC5543597 DOI: 10.1186/s12893-017-0284-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. Methods State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€). Results Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs. Conclusions Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
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Affiliation(s)
| | - Oliver Mann
- University Medical Center Hamburg, Hamburg, Germany
| | - Anna Duprée
- University Medical Center Hamburg, Hamburg, Germany
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Abstract
The epidemic-like increase of obesity in all western countries is associated with a growing incidence of morbid obesity. Here, efficient and lasting weight loss is mostly obtained by surgical interventions today performed in a reliable and safe manner. In that way comorbidities associated with obesity can be reduced or abolished. Treating the sequelae of bariatric surgery, with frequent massive weight loss and generalized skin excess, is challenging for the plastic surgeon. The goal is to restore a normal body contour as a prerequisite for complete psychosocial integration of the patients, who are often stigmatized by their outward appearance not only before but also after the weight loss. The present work provides an overview of current concepts and trends in post-bariatric plastic surgery.
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Affiliation(s)
- O Scheufler
- Abteilung für Plastische, Rekonstruktive und Asthetische Chirurgie, Universitätsspital Basel, Spitalstrasse 21, 4031 Basel, Schweiz.
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