Use And Costs Of Bariatric Surgery And Prescription Weight-Loss Medications

Encinosa, William; Bernard, Didem; Steiner, Claudia; Chen, Chi Chang

doi:10.1377/hlthaff.24.4.1039

Cited by 107 publications

(61 citation statements)

References 13 publications

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“…A key limitation is that the majority of the study population is women, which is perhaps explained by the relative distribution of bariatric surgery in men versus women. 43 This study repurposed administrative data from Memorial Hermann's EPSI database. Since administrative data were used to identify ORADEs and relied on documentation of specific ICD-9-CM codes, the true incidence of ORADEs in this population may be greater than what was have the potential to improve the postsurgical experience for the patient and reduce costs for hospitals and may be more cost-efficient than interventions applied to the entire surgical population.…”

Section: Limitationsmentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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Section: Limitationsmentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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“…[1][2][3] Unfortunately, the high cost (ranging from $18 000 to $25 000) 4,5 makes self-pay untenable for most bariatric patients, forcing them to rely on third party payment. 6 US insurance carriers generally offer coverage for these procedures to candidates meeting the NIH criteria, but often require participation in a 6-month, physician-supervised weight loss regimen.…”

Section: Introductionmentioning

confidence: 99%

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

et al. 2012

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Pre-bariatric surgery requirements vary between surgeons and surgical centers, with standards of practice not yet established. The goal of this systematic review was to summarize and evaluate the available literature on pre-bariatric surgery weight loss requirements and the relation between preoperative weight loss and postoperative outcome. Major databases, including Medline, PubMed and PsychINFO were searched for relevant articles. Case studies, studies420 years old and studies that utilized selfreported body weight data were excluded. Data on the effect of the following was summarized: (1) preoperative requirements on preoperative weight loss; (2) insurance-mandated preoperative requirements; (3) the contingency of receipt of surgery; (4) preoperative weight loss on postoperative weight loss and (5) preoperative weight loss on perioperative and postoperative complication and comorbidity rates. The majority of studies suggest that: (1) current preoperative requirements held by the majority of third party payer organizations in the United States are ineffective in fostering preoperative weight loss; (2) making receipt of surgery contingent upon achieving preoperative weight loss, and meal-replacement diets, may be particularly effective in fostering preoperative weight loss and (3) preoperative weight loss may lead to improvements in at least some relevant postoperative outcomes. However, a preoperative weight loss mandate may lead to the denial of surgery and subsequent health benefits to individuals who are unable to achieve a prespecified amount of weight. Overall, the limited number and quality of prospective studies in this area prohibits the much-needed establishment of standards of practice for pre-bariatric requirements.

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“…In 2005, 180,000 bariatric procedures were performed, and in 2006, over 200,000 procedures are expected 8 . Factors contributing to such growth may include the prevalence of obesity, the increase in reports of surgical efficacy, the availability of less invasive procedures, and the media exposure of successful bariatric procedures 9 . Still, less than 1% of the 23 million morbidly obese patients in the United States undergo bariatric procedures.…”

Section: Introductionmentioning

confidence: 99%

“…Still, less than 1% of the 23 million morbidly obese patients in the United States undergo bariatric procedures. 9 One possible explanation for the disparity between potentially eligible patients and numbers of procedures performed is financial, i.e., patients may not be able to gain insurance coverage or have the ability to pay for a procedure out of pocket. Another potential reason is uncertainty regarding potential risks and benefits among both patients and referring physicians.…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery

Belle

Berk

Courcoulas

et al. 2007

Surgery for Obesity and Related Diseases

232

210

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Background-Obesity is a leading health concern in the United States. Since traditional treatment approaches for weight loss are generally unsuccessful long-term 1 , bariatric surgical procedures are increasingly being performed to treat extreme obesity. To facilitate research in this field, the National Institute of Diabetes and Digestive and Kidney Diseases responded to this knowledge gap by establishing the Longitudinal Assessment of Bariatric Surgery (LABS) consortium.

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Use And Costs Of Bariatric Surgery And Prescription Weight-Loss Medications

Cited by 107 publications

References 13 publications

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Pre-bariatric surgery weight loss requirements and the effect of preoperative weight loss on postoperative outcome

Safety and efficacy of bariatric surgery: Longitudinal Assessment of Bariatric Surgery

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