Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

Abstract

IMPORTANCE Information on the associations between barriers to delivery of bariatric surgery and poor weight trajectory afterward is lacking. Estimates are needed to inform decisions by administrators and clinicians to improve care. OBJECTIVE To estimate the difference in patient-years of treatment for diabetes, hypertension, and dyslipidemia and public-payer cost between the Canadian standard and an improved bariatric surgery care pathway. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation of a decision analytic model comparing the outcomes of the standard care in Canada with an improved bariatric care pathway with earlier sleeve gastrectomy delivery and better postsurgical weight trajectory. The model was informed by published clinical data (101 studies) and meta-analyses (11 studies) between January and May 2019. Participants were a hypothetical 100-patient cohort with demographic characteristics derived from a Canadian study. INTERVENTIONS Reduction of Canadian mean bariatric surgery wait time by 2.5 years following referral and improvement of patient postsurgery weight trajectory to levels observed in other countries. MAIN OUTCOMES AND MEASURES Modeling weight trajectory after sleeve gastrectomy and resolution rates for comorbidities in Canada in comparison with an improved care pathway to estimate differences in patient-years of comorbidity treatment over 10 years following referral and the associated costs. RESULTS For the 100-patient cohort (mean [SD] 88.2% [1.4%] female; mean [SD] age, 43.6 [9.2] years; mean [SD] body mass index, 49.4 [8.2]; and mean [SD] comorbidity prevalence of 50.0% [4.1%], 66.0% [3.9%], and 59.3% [4.0%] for diabetes, hypertension, and dyslipidemia, respectively) over 10 years following referral, the improved vs standard care pathway was associated with median reduction in patient-years of treatment of 324 (95% credibility interval [CrI], 249-396) for diabetes, 245 (95% CrI, 163-356) for hypertension, and 255 (95% CrI, 169-352

Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis

“…Data from the UK National Bariatric Surgery Registry establish that at the time of primary surgery 53.9% of men and 41.4% of women already have a high level of co-existing disease (defined as 4 or more obesity-related diseases) [20]. Previous studies have also demonstrated that improving pathways to bariatric surgery can reduce the healthcare burden upon individuals and lead to overall healthcare cost savings [21].…”

Earlier Provision of Gastric Bypass Surgery in Canada Enhances Surgical Benefit and Leads to Cost and Comorbidity Reduction

“…A previous analysis considered cost and disease treatment outcomes in Canada for SG surgery (13). While SG appears to be increasing in use around the world, including in Canada (5), RYGB continues to be a widely applied surgery in the Canadian setting, although its application varies widely by province.…”

“…Inclusion of a weight loss program in bariatric surgical programs across Canada is unknown. A previous study considered mild weight gain in the presurgical period ( 13 ), but as a more conservative approach in the present analysis, patients are taken to have stable weight on average; the sensitivity analysis includes possibilities of weight gain and weight loss during the presurgical period.…”

“…A recent study of patients in the Ontario Bariatric Network, a centralized management system for all bariatric surgery referrals in the province, noted the potential negative cost impact of prolonged presurgical patient workup and its contribution to patient attrition ( 11 ). Other modeling studies based on published data from Canada have sought to quantify the cost burden associated with the current standard of care in comparison to an improved complete SG bariatric surgery care pathway in Canada ( 13 ), and focused on the post-surgical period for RYGB ( 14 ). These studies identified potential savings in costs and reduced patient comorbidity with realistic improvements to the presurgical wait time and post-surgical weight loss trajectories.…”

Does bariatric surgery reduce future hospital costs? A propensity score-matched analysis using UK Biobank Study data

“…Several studies have measured the medical costs incurred by patients with bariatric surgery in other countries [28][29][30][31][32] . Nevertheless, different healthcare systems and analytic perspectives made these results not generalizable to the UK.…”