© FD-Communications Inc. Obesity Surgery, 14, 2004 1031
Obesity Surgery, 14, 1031-1035
Background:This study examines the effect of weight loss following laparoscopic Roux-en-Y gastric bypass (RYGBP) for morbid obesity on prescription drug costs in patients over the age of 54.
Methods: 78 patients aged 55 to 75 who met the inclusion criteria were identified in a database of 1,060 morbidly obese patients undergoing LRYGBP between March 2001 and March 2003. All prescription drugs and dosages were recorded preoperatively and postoperatively at 6 months, 1 year, and yearly thereafter. Drug history was obtained from the patient and verified by records from referring physicians’ offices.
The cost of a 30-day supply of each drug was obtained from 3 retail sources and averaged.
Results: The average pre-LRYGBP cost of prescription drugs was $368.65 per month per patient. The average annualized cost at 6 months after LRYGBP was $119.10 per month (down 68%), at 1 year $118.67 (down 68%) and at 2 years $104.68 per month (down 72%).
Conclusions: Weight loss resulting from LRYGBP significantly reduces obesity-related morbidities, resulting in a substantial reduction in medication needs in patients over the age of 54. The projected cost savings realized in the 78 patients in this study amounts to approximately $240,566.04 annually.
Key words: Morbid obesity, bariatric surgery, gastric bypass, benefits, costs, drug costs
Because of increase in the rate of morbid obesity and the introduction of the laparoscopic Roux-en-Y gastric bypass (LRYGBP),1 the demand for bariatric surgery has dramatically increased in recent years.
Approximately 100,000 bariatric procedures were performed in the United States in 2003, and an estimated 144,000 will be performed in 2004.
Ostensibly, this has placed an economic burden on private and public health-care insurers, resulting in efforts to compensate for the additional costs of surgery. The options are to raise premiums, reduce reimbursements, increase patient co-payments or deny coverage for the procedure. Rather than raising premiums, the trend has been to shift costs to providers by reducing allowable charges and to the morbidly obese patient by denying coverage or raising co-payments. The medical costs to treat obesity and obesity-related morbidities have also risen.
According to the Centers for Disease Control and
Prevention, the direct and indirect annual medical cost to treat obesity and obesity-related morbidities in the U.S.A. in 1998 was 78.5 billion dollars, which would be equivalent to 92.6 billion in 2002 dollars.2
These economic issues generated two related hypotheses: The first hypothesis was that surgery is more effective therapeutically and economically for the treatment of both obesity and obesity-related morbidities than drugs. The second hypothesis was that the benefits of bariatric surgery pay for the costs of surgery in a reasonable period of time.
The Effect of Roux-en-Y Gastric Bypass on Prescription Drug Costs
L. Lamar Snow, MD; L. Steve Weinstein, MD; Jeffrey K. Hannon, MD;
Daniel R. Lane, MD; Forrest G. Ringold MD; Peggy A. Hansen, MD;
Michael D. Pointer, PA-C
Surgical Association of Mobile PA, Departments of Surgery, Mobile Infirmary Medical Center and
University of South Alabama College of Medicine, Mobile, AL, USA
Reprint requests to: L. Lamar Snow, MD, FACS, 3 Mobile
Infirmary Cir., Ste. 212, Mobile, Al 36607, USA. Fax: 251-4389607; e-mail: SampaDocs@aol.com
A narrow study was designed to test these hypotheses by comparing the cost and effectiveness of surgery in the patients studied, using the methods described against the cost and effectiveness of medical treatment using a single surgical benefit – savings in prescription drug costs.
Materials and Methods
All patients over the age of 54 in a database of 1,060 patients in whom a LRYGBP was attempted between March, 2001 and March, 2003 with a minimum of 6 months follow-up were included.
Patients who died or were lost to follow-up within 6 months of surgery were excluded.
Pertinent data including patient’s age, weight, body mass index (BMI), morbidities and lists of prescription drugs and dosages were prospectively recorded preoperatively and postoperatively at 6 months and yearly thereafter. Prescription drug data were obtained from the patient and later verified by the patient’s primary care and other physicians’ recorded history and office records. The cost of a 30-day supply of each drug was obtained from three retail sources and averaged. The average drug costsavings was calculated on a monthly and yearly basis, by subtracting the average cost at each postoperative time interval from the average preoperative cost. The mean cost per episode for a LRYGBP during the study period was obtained from the data bank of a single insurer that insured over 75% of the patients in our database. Costs included the average of all payments including patient co-payments to the surgeon, assistant surgeon, consultants, anesthesiologist, pathologist, radiologist and the hospital.
Results were analyzed for statistical significance using one or two way analysis of variance where appropriate, using SPSS v.11 (SPSS Inc. Chicago,
IL). Significance was set at P <.05.
There were 82 patients over the age of 54 identified in a database of 1,060 LRYGBP operations performed from April 15, 2001 through April 15, 2003.
Of these, 78 patients met the inclusion criteria. Age ranged from 55 to 75, with a mean of 60 years.
There were 17 males (22%) and 61 females (78%).
Weight ranged from 85 to 226 kg with a mean of 136 kg. BMI ranged from 36 to 70, with a mean of 48 kg/m2. There was an average of 3 obesity-related co-morbidities per patient, versus 1 per patient in the 977 patients below the age of 55 years.
Morbidities are listed in Table 1. Mean operating time was 124 minutes. Ten patients (12.4%) were converted to open. Mean estimated blood loss
Snow et al 1032 Obesity Surgery, 14, 2004
Table 1. Co-morbidities requiring prescription drugs. Number of drugs, number of patients taking drugs and percentage decrease in number of drugs for each morbidity at each time interval