Weight-loss surgery may not cut medical costs

Although patients do indeed lose weight after bariatric surgery, health-care costs remain about the same as they were before the procedure, according to a new study. Bariatric surgery reduces the size of the stomach, which results in significant weight loss. Most patients in the new study had undergone a procedure called Roux-en-Y gastric bypass. Previous studies had shown that many obese people who have this procedure improve their health and reduce the cost of their care. In this group of patients, however, costs did not go down, the researchers said. "These three-year findings suggest that the return on investment for bariatric surgery isn't seen," said lead researcher Matthew Maciejewski, from the Center for Health Services Research in Primary Care at the Durham VA Medical Center, in North Carolina. "It is possible, however, that if we could follow these [patients] for another three to five years, cost reduction may be seen," he said. Bariatric surgery improved these patients' health in the short term, but without further weight loss or other lifestyle modifications, their risk remains high, he added. Maciejewski said these patients, like most patents who have weight-loss surgery, gain much of the weight back, which may be why costs remain the same as before surgery. The report was published in the July issue of the journal Archives of Surgery. For the study, Maciejewski's team looked at health-care spending in nearly 850 U.S. military veterans who had weight-loss surgery, comparing them to a similar number of veterans who didn't. The researchers analyzed expenditures for the three years before and after surgery. The researchers found that in the years before surgery, hospital inpatient and outpatient costs for people who had bariatric surgery were about $600 lower than for those who didn't have the procedure. In the six months before surgery, however, the costs were $28,400 higher, including the operation. Costs were almost $4,400 higher in the first six months after surgery, but then dropped to about the same level as before the procedure, the researchers found. These findings, however, may only apply to this particular group of patients, who were mostly male, older and sicker than other patients who have weight-loss surgery, the researchers noted. In other groups, the procedure may reduce health-care spending. Dr. Mitchell Roslin, chief of bariatric surgery at Lenox Hill Hospital in New York City, said patients should not be looking for a return on investment from any medical procedure. "We do this medical procedure to make people improve medically -- get rid of their diabetes, their sleep apnea -- and feel better about themselves and let them have an improved quality of life," he said. Roslin said the notion of cost reduction was something that "people created to try to get coverage for bariatric surgery. I don't believe, in a system like ours, there will ever be a return on investment for any medical procedure."