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Tarride JE, Doumouras AG, Hong D, Paterson JM, Tibebu S, Perez R, Ma J, Taylor VH, Xie F, Boudreau V, Pullenayegum E, Urbach DR, Anvari M. Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada. JAMA Surg 2020; 155:e201985. [PMID: 32697298 DOI: 10.1001/jamasurg.2020.1985] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Results of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB). Objective To assess the 5-year incremental health care use and expenditures after RYGB. Design, Setting, and Participants This population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020. Intervention RYGB procedure. Main Outcomes and Measures The primary outcome was total health care expenditures. Results The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean [SD] age, 47 [10.2] years) and 1587 controls (mean [SD] age, 47 [12.2] years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars) per patient in the RYGB group increased from CAD $15 594 (95% CI, CAD $14 743 to CAD $16 614) (US $12 008 [95% CI, US $11 353 to US $12 794]) in the 5 years before the procedure to CAD $30 389 (95% CI, CAD $28 789 to CAD $32 232) (US $23 401 [95% CI, US $22 169 to US $24 821]) over the 5 years after the procedure, a difference of CAD $14 795 (95% CI, CAD $13 172 to CAD $16 480) (US $11 393 [95% CI, US $10 143 to US $12 691]). For the control group, mean total health care expenditures per individual increased from CAD $16 109 (95% CI, CAD $14 727 to CAD $17 591) (US $12 405 [95% CI, US $11 341 to US $13 546]) 5 years before the index date to CAD $20 073 (95% CI, CAD $18 147 to CAD $22 169) (US $15 457 [95% CI, US $13 974 to US $17 071]) 5 years after the date, a difference of CAD $3964 (95% CI, CAD $2250 to CAD $5875) (US $3053 [95% CI, US $1733 to US $4524]). Overall, the difference-in-differences estimate of the net cost of RYGB was CAD $10 831 (95% CI, CAD $8252 to CAD $13 283) (US $8341 [95% CI, $6355 to $10 229]) over the 5-year period. This amount excluded the mean (SD) cost associated with the index date: CAD $6501 (CAD $1087) (US $5006 [US $837]) for the RYGB cohort and CAD $9 (CAD $72) (US $7 [US $55]) for the controls. The cost differential was primarily associated with increased hospitalizations in the first months immediately after RYGB. Expenditures leveled off in year 3 after the index date; differences in total expenditures between the RYGB and control cohorts were not statistically significantly different in years 4 and 5. Conclusions and Relevance Health care expenditures in the 3 years after publicly funded RYGB were higher in patients who underwent the procedure than in control individuals, but the costs were similar thereafter. This finding suggests the need to decrease hospital and emergency department readmissions after surgical bariatric procedures because such use is associated with increased spending.
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Affiliation(s)
- Jean-Eric Tarride
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.,Programs for Assessment of Technology in Health (PATH), The Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Aristithes G Doumouras
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - J Michael Paterson
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - Vanessa Boudreau
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Eleanor Pullenayegum
- Dalla Lana School of Public Health, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.,Hospital for Sick Children, Toronto, Ontario, Canada
| | - David R Urbach
- Women's College Hospital Research Institute, Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mehran Anvari
- Division of General Surgery, McMaster University, Hamilton, Ontario, Canada.,Centre for Minimal Access Surgery, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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2
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Rubino F, Cohen RV, Mingrone G, le Roux CW, Mechanick JI, Arterburn DE, Vidal J, Alberti G, Amiel SA, Batterham RL, Bornstein S, Chamseddine G, Del Prato S, Dixon JB, Eckel RH, Hopkins D, McGowan BM, Pan A, Patel A, Pattou F, Schauer PR, Zimmet PZ, Cummings DE. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery. Lancet Diabetes Endocrinol 2020; 8:640-648. [PMID: 32386567 PMCID: PMC7252156 DOI: 10.1016/s2213-8587(20)30157-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.
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Affiliation(s)
- Francesco Rubino
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK; Bariatric and Metabolic Surgery, King's College Hospital, London, UK.
| | - Ricardo V Cohen
- Center for the treatment of Obesity and Diabetes, Oswaldo Cruz German Hospital, Sao Paulo, Brazil
| | - Geltrude Mingrone
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College of Dublin, Dublin, Ireland
| | - Jeffrey I Mechanick
- The Marie-Josee and Henry R Kravis Center for Clinical Cardiovascular Health at Mount Sinai Heart, New York, NY, USA; Divisions of Cardiology and Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Josep Vidal
- Endocrinology and Nutrition Department, Hospital Clinic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - George Alberti
- Department of Endocrinology and Metabolism, Imperial College, London, UK
| | - Stephanie A Amiel
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Rachel L Batterham
- Centre for Obesity Research, University College London, London, UK; University College London Hospitals Bariatric Centre for Weight Management and Metabolic Surgery, London, UK; National Institute of Health Research University College London Hospitals Biomedical Research Centre, London, UK
| | - Stefan Bornstein
- Paul Langerhans Institute Dresden, Helmholtz Center Munich at the University Hospital Carl Gustav Carus and Faculty of Medicine, Technical University Dresden, Dresden, Germany
| | | | - Stefano Del Prato
- Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes, University of Pisa, Pisa, Italy
| | - John B Dixon
- Iverson Health Innovation Research Institute, Swinburne University, Melbourne, VIC, Australia
| | - Robert H Eckel
- Division of Endocrinology, Metabolism and Diabetes and Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David Hopkins
- King's Health Partners' Institute of Diabetes, Endocrinology and Obesity, London, UK
| | - Barbara M McGowan
- Institute of Diabetes, Endocrinology and Obesity, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ameet Patel
- Bariatric and Metabolic Surgery, King's College Hospital, London, UK
| | - François Pattou
- European Genomic Institute for Diabetes, Lille, France; Translational Research for Diabetes, University of Lille, Inserm, Centre Hospitalier Regional Universitaire, Lille, France
| | - Philip R Schauer
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA
| | - Paul Z Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - David E Cummings
- University of Washington Medicine Diabetes Institute, University of Washington, Seattle, WA, USA; Weight Management Program, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA, USA
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3
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Smith VA, Arterburn DE, Berkowitz TSZ, Olsen MK, Livingston EH, Yancy WS, Weidenbacher HJ, Maciejewski ML. Association Between Bariatric Surgery and Long-term Health Care Expenditures Among Veterans With Severe Obesity. JAMA Surg 2019; 154:e193732. [PMID: 31664427 DOI: 10.1001/jamasurg.2019.3732] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Bariatric surgery has been associated with improvements in health in patients with severe obesity; however, it is unclear whether these health benefits translate into lower health care expenditures. Objective To examine 10-year health care expenditures in a large, multisite retrospective cohort study of veterans with severe obesity who did and did not undergo bariatric surgery. Design, Setting, and Participants A total of 9954 veterans with severe obesity between January 1, 2000, and September 30, 2011, were identified from veterans affairs (VA) electronic health records. Of those, 2498 veterans who underwent bariatric surgery were allocated to the surgery cohort. Sequential stratification was used to match each patient in the surgery cohort with up to 3 patients who had not undergone bariatric surgery but were of the same sex, race/ethnicity, diabetes status, and VA regional network and were closest in age, body mass index (calculated as weight in kilograms divided by height in meters squared), and comorbidities. A total of 7456 patients were identified and allocated to the nonsurgery (control) cohort. The VA health care expenditures among the surgery and nonsurgery cohorts were estimated using regression models. Data were analyzed from July to August 2018 and in April 2019. Interventions The bariatric surgical procedures (n = 2498) included in this study were Roux-en-Y gastric bypass (1842 [73.7%]), sleeve gastrectomy (381 [15.3%]), adjustable gastric banding (249 [10.0%]), and other procedures (26 [1.0%]). Main Outcomes and Measures The study measured total, outpatient, inpatient, and outpatient pharmacy expenditures from 3 years before surgery to 10 years after surgery, excluding expenditures associated with the initial bariatric surgical procedure. Results Among 9954 veterans with severe obesity, 7387 (74.2%) were men; the mean (SD) age was 52.3 (8.8) years for the surgery cohort and 52.5 (8.7) years for the nonsurgery cohort. Mean total expenditures for the surgery cohort were $5093 (95% CI, $4811-$5391) at 7 to 12 months before surgery, which increased to $7448 (95% CI, $6989-$7936) at 6 months after surgery. Postsurgical expenditures decreased to $6692 (95% CI, $6197-$7226) at 5 years after surgery, followed by a gradual increase to $8495 (95% CI, $7609-$9484) at 10 years after surgery. Total expenditures were higher in the surgery cohort than in the nonsurgery cohort during the 3 years before surgery and in the first 2 years after surgery. The expenditures of the 2 cohorts converged 5 to 10 years after surgery. Outpatient pharmacy expenditures were significantly lower among the surgery cohort in all years of follow-up ($509 lower at 3 years before surgery and $461 lower at 7 to 12 months before surgery), but these cost reductions were offset by higher inpatient and outpatient (nonpharmacy) expenditures. Conclusions and Relevance In this cohort study of 9954 predominantly older male veterans with severe obesity, total health care expenditures increased immediately after patients underwent bariatric surgery but converged with those of patients who had not undergone surgery at 10 years after surgery. This finding suggests that the value of bariatric surgery lies primarily in its associations with improvements in health and not in its potential to decrease health care costs.
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Affiliation(s)
- Valerie A Smith
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle.,Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle
| | - Theodore S Z Berkowitz
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Maren K Olsen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Edward H Livingston
- Department of Surgery, University of California, Los Angeles, Los Angeles.,Division of General Surgery, Northwestern University, Chicago, Illinois.,Deputy Editor
| | - William S Yancy
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Hollis J Weidenbacher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina
| | - Matthew L Maciejewski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
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4
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide current synthesis of the evidence on the cost-effectiveness of bariatric surgery for persons with diabetes. RECENT FINDINGS Virtually, every study that has evaluated the cost-effectiveness of bariatric surgery for persons who are obese and have type 2 diabetes has concluded that surgery is cost-effective. A few studies outside the USA found that surgery is cost-saving. Currently, most but not all US insurers cover bariatric surgery in persons with type 2 diabetes and BMI ≥ 35 kg/m2. Bariatric surgery is a cost-effective treatment for persons with type 2 diabetes and BMI ≥ 35 kg/m2. There is interest in extending surgery to persons with diabetes and lower BMI; the cost-effectiveness of treating these individuals with bariatric surgery should be explored. Despite the potential benefits, not all obese or overweight persons with diabetes will choose surgery.
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Affiliation(s)
- Thomas J Hoerger
- Public Health Economics Program, RTI International, 3040 Cornwallis Road, Research Triangle Park, Durham, NC, 27709, USA.
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5
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Dixon JB, Eaton LL, Curry T, Lee PC. Health Outcomes and Explant Rates After Laparoscopic Adjustable Gastric Banding: A Phase 4, Multicenter Study over 5 Years. Obesity (Silver Spring) 2018; 26:45-52. [PMID: 29265773 DOI: 10.1002/oby.22050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/26/2017] [Accepted: 09/19/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to evaluate the real-world safety and effectiveness of the LAP-BAND (Apollo Endosurgery Inc., Austin, Texas) adjustable gastric banding system (LBS) for 5 years following implantation. METHODS This prospective, longitudinal, phase 4, multicenter study involved 652 patients who had implantation of the LBS system. The primary outcome was the percentage of subjects who had LBS explant over 5 years. The secondary outcomes included the rate of reoperations, clinical and biochemical measures, and patient-reported outcome measures over 5 years. RESULTS The study cohort consisted of 79.3% females with a mean age of 44 years and a mean BMI of 45.4 kg/m2 . The primary end point was met with an explant rate of 8.74% (95% CI: 6.6%-10.9%) at 5 years. The rates for completer-only analysis and imputed missing data analysis were 12.81% (95% CI: 9.7%-15.9%) and 12.85% (95% CI: 10.2%-15.5%), respectively. All were significantly lower than the historic rate of 39.4% (P < 0.001). There were 43 patients who required reoperations or revisions excluding explants (6.6%). A mean weight loss of 18.7% was maximally achieved by 2 years, and weight loss was maintained through to 5 years. All patient-reported outcomes showed improvement following LBS treatment throughout 5 years. CONCLUSIONS This study validates the long-term safety and effectiveness of LBS for the treatment of patients with obesity and its related conditions.
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Affiliation(s)
- John B Dixon
- Clinical Obesity Research, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Trace Curry
- JourneyLite Surgery Centre, Cincinnati, Ohio, USA
| | - Phong Ching Lee
- Obesity and Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore
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6
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Patient-reported quality of life after bariatric surgery: a single institution analysis. J Surg Res 2017; 218:117-123. [PMID: 28985837 DOI: 10.1016/j.jss.2017.05.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/24/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bariatric surgery is an effective weight loss and comorbidity treatment among severely obese patients. However, there are limited data describing its impact on patient-reported quality of life (QoL). We examined patient-reported QoL after bariatric surgery and analyzed variables associated with higher postoperative QoL. METHODS Patient demographics, comorbidities, and weight loss data were obtained from our institutional database for patients who underwent bariatric surgery from January 2010 to December 2012. QoL scores were obtained during preoperative and postoperative visits (2, 6, 12, 24, 52, and 104 wk) from the Moorehead-Ardelt Quality of Life Questionnaire II. Multivariable logistic regression was performed to generate odds ratios for variables hypothesized a priori to be associated with higher postoperative QoL. RESULTS A total of 209 patients were included in the study. Patients lost an average of 59.1% (±19.0) of excess body weight 1 y after surgery. One-year postoperative QoL scores were available for 42% of patients. Mean QoL scores improved from 0.82 preoperatively to 1.66 1 y postoperatively (P = 0.004). Patients scored higher in all individual areas of Moorehead-Ardelt Quality of Life Questionnaire II: self-esteem (0.22 versus 0.36), physical activity (0.11 versus 0.31), social life (0.28 versus 0.36), work ability (0.07 versus 0.22), sexual functioning (0.04 versus 0.16), and approach to food (0.11 versus 0.26; all P values <0.05). On multivariable analysis, higher QoL was associated with private insurance/self-pay versus Medicare (odds ratio 4.20 [95% confidence interval 1.39-12.68]). CONCLUSIONS Bariatric surgery patients experienced significant improvement in QoL 1 y after surgery. Identifying modifiable predictors of high QoL after bariatric surgery requires additional investigation.
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Funk LM, Gunnar W, Dominitz JA, Eisenberg D, Frayne S, Maggard-Gibbons M, Kalarchian MA, Livingston E, Sanchez V, Smith BR, Weidenbacher H, Maciejewski ML. A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration. J Gen Intern Med 2017; 32:65-69. [PMID: 28271434 PMCID: PMC5359154 DOI: 10.1007/s11606-016-3951-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and bariatric surgery workgroups. This article summarizes the bariatric surgery workgroup (BSWG) findings and recommendations for future research. The BSWG agreed that there is evidence from randomized trials and large observational studies suggesting that bariatric surgery is superior to medical therapy for short- and intermediate-term remission of type 2 diabetes, long-term weight loss, and long-term survival. Priority evidence gaps include long-term comorbidity remission, mental health, substance abuse, and health care costs. Evidence of the role of endoscopic weight loss options is also lacking. The BSWG also noted the limited evidence regarding optimal timing for bariatric surgery referral, barriers to bariatric surgery itself, and management of high-risk bariatric surgery patients. Clinical trials of pre- and post-surgery interventions may help to optimize patient outcomes. A registry of overweight and obese veterans and a workforce assessment to determine the VHA's capacity to increase bariatric surgery access were recommended. These will help inform policy modifications and focus the research agenda to improve the ability of the VHA to deliver population-based weight management.
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Affiliation(s)
- L M Funk
- William S. Middleton VA Hospital, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - W Gunnar
- The George Washington University, Washington, DC, USA
| | - J A Dominitz
- U.S. Department of Veterans Affairs, Washington, DC, USA.,Division of Gastroenterology, University of Washington, Seattle, WA, USA
| | - D Eisenberg
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - S Frayne
- VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - M Maggard-Gibbons
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - M A Kalarchian
- School of Nursing and Department of Psychology, Duquesne University, Pittsburgh, PA, USA
| | - E Livingston
- JAMA, Chicago, IL, USA.,Department of Surgery at the UT Southwestern School of Medicine, Dallas, TX, USA
| | - V Sanchez
- VA Boston Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - B R Smith
- VA Long Beach Healthcare System, Long Beach, CA, USA.,Department of Surgery, UC Irvine Medical Center, Irvine, CA, USA
| | - H Weidenbacher
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA.,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27705, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
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8
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Campbell JA, Venn A, Neil A, Hensher M, Sharman M, Palmer AJ. Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review. Obes Rev 2016; 17:850-94. [PMID: 27383557 DOI: 10.1111/obr.12424] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 03/29/2016] [Accepted: 04/08/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery. METHODS Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews. RESULTS Six thousand one hundred eighty-seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third-party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter-term outpatient). Out-of-pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one-third of studies. Body-contouring surgery included in only 14%. One study evaluated long-term waitlisted patients. Surgery was cost-effective/cost-saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent. DISCUSSION There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.
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Affiliation(s)
- J A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Hensher
- Department of Health and Human Services, Hobart, Tasmania, Australia
| | - M Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - A J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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9
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Bhatti JA, Nathens AB, Thiruchelvam D, Redelmeier DA. Weight loss surgery and subsequent emergency care use: a population-based cohort study. Am J Emerg Med 2016; 34:861-5. [DOI: 10.1016/j.ajem.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 01/01/2023] Open
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10
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Funk LM, Jolles S, Fischer LE, Voils CI. Patient and Referring Practitioner Characteristics Associated With the Likelihood of Undergoing Bariatric Surgery: A Systematic Review. JAMA Surg 2016. [PMID: 26222655 DOI: 10.1001/jamasurg.2015.1250] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for this low use are unclear. OBJECTIVES To identify patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery. EVIDENCE REVIEW The PubMed, PsycINFO, CINAHL, and Cochrane databases were searched for articles published from January 1, 1998, through December 31, 2014. Studies were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or practitioner characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding. FINDINGS Of the 7212 records identified in the initial search, 53 were included in full-text review. Nine studies met our inclusion criteria and were included in analyses. Of those, 4 included descriptive findings, 6 reported statistical associations, and 1 included both. One study included practitioners as participants, whereas 8 included patients. Four of 9 studies identified an association between female sex and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in 2 studies. Five of 9 cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring practitioners. Practitioners who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery. CONCLUSIONS AND RELEVANCE Limited patient and referring practitioner knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery use. Future efforts focused on improving knowledge and identification of the critical determinants of obesity treatment decision making from the practitioner and patient perspectives would have an important effect on public health.
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Affiliation(s)
- Luke M Funk
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison2William S. Middleton Veterans Affairs Memorial Hospital, Madison, Wisconsin
| | - Sally Jolles
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison2William S. Middleton Veterans Affairs Memorial Hospital, Madison, Wisconsin
| | - Laura E Fischer
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin School of Medicine and Public Health, Madison
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina4Department of Medicine, Duke University Medical Center, Durham, North Carolina
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Frois C, Cremieux PY. For a Step Change to Curb the Obesity Epidemic. PHARMACOECONOMICS 2015; 33:613-617. [PMID: 26068946 DOI: 10.1007/s40273-015-0303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Christian Frois
- Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor, Boston, MA, 02199-7668, USA
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Chawla AS, Hsiao CW, Romney MC, Cohen R, Rubino F, Schauer P, Cremieux P. Gap Between Evidence and Patient Access: Policy Implications for Bariatric and Metabolic Surgery in the Treatment of Obesity and its Complications. PHARMACOECONOMICS 2015; 33:629-641. [PMID: 26063335 DOI: 10.1007/s40273-015-0302-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Despite consistently supportive evidence of clinical effectiveness and economic advantages compared with currently available non-surgical obesity treatments, patient access to bariatric and metabolic surgery (BMS) is impeded. To address this gap and better understand the relationship between value and access, the objectives of this study were twofold: (i) identify the multidimensional barriers to adoption of BMS created by clinical guidelines, public policies, and health technology assessments; and, most importantly, (ii) develop recommendations for stakeholders to improve patient access to BMS. Updated public policies focused on treatment and clinical guidelines that reflect the demonstrated advantages of BMS, patient education on safety and effectiveness, updated reimbursement policies, and additional data on long-term BMS effectiveness are needed to improve patient access.
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Affiliation(s)
- Amarpreet S Chawla
- Quintiles Advisory Services, 4820, Emperor Blvd, Durham, NC, 27703, USA,
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