Long-Term Inpatient Hospital Utilisation and Costs (2007–2008 to 2015–2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia’s Activity-Based Funding Model

Abstract

BackgroundWithin the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model.ObjectiveWe aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system.MethodsHospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted.ResultsA total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267.ConclusionsTaking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.

Resource utilization and disaggregated cost analysis of bariatric surgery in the Australian public healthcare system

“…We used the latest available data to generate the estimates of direct medical costs associated with primary bariatric surgery in an Australian public hospital setting. Importantly, in addition to updating the aggregated costs of bariatric surgery from our previous pilot study [18], this study complements the previous findings regarding the disaggregated bariatric-related costs and their contributions over time, concluding that resource utilization patterns and costs for bariatric are changing, which is as expected from the changing incidence of surgery type in Australia over time.…”

“…This study also provides the updated aggregated costs of bariatric surgery based on the latest Australian data. We found that the latest costs for GB ($10,049) and SG ($12,632) were similar while slightly lower than these in Australian fiscal years 2007/08 to 2015/16 (GB: $14,622 and SG: $15,014) [18]. This can be explained by the consideration of surgical sequelae (including secondary surgery) for GB patients in our previous study, which accounted for a mean cost of $6,267.…”

“…Disaggregated costs are episode costs reported into their component costs or cost buckets. The details regarding the costing methodology were described in our previous study [18] and are described briefly here. A bottom-up costing approach for resource use was adopted.…”

“…There are only six publications outside Australia that consider the disaggregated components of bariatric surgery-related utilization and costs (Table 1) [11][12][13][14][15][16]. Within the Australian setting, the Australian Institute for Health and Welfare (AIHW) report and our previous pilot cost study only provided aggregated estimates for bariatric surgery episodes of care [17,18]. The substantially high costs of bariatric surgery are recognized, but we have little knowledge of the scale, profile, or determinants of these costs in the Australian healthcare setting.…”

“…Continuing on from our previous National Health and Medical Research Council (NHMRC) partnership project regarding the aggregated costs for patients receiving bariatric surgery (for Australian fiscal years 2007/2008 to 2015/2016) [18], this study aimed to provide the first detailed characterization of the scale, disaggregated profile, and determinants of healthcare costs associated with primary bariatric surgery for the fiscal years 2013/14 to 2018/19 in an Australian publicly funded hospital setting.…”