NATIONAL HARBOR, MD. — Gastric bypass surgery that corrects hypertension and diabetes can save thousands of dollars in medication costs over a lifetime, according to a retrospective study of more than 100 patients.
Even patients whose diseases improve but do not remit after surgery will see a significant cost benefit in their medications, Dr. Saber Ghiassi said at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons.
He identified the savings in a population of Veterans Affairs patients, who have access to very inexpensive medications. Savings would be much greater in the general population, where drug costs are not controlled, he noted.
Dr. Ghiassi, a postdoctoral surgical fellow at Stanford (Calif.) University, reviewed the charts of 106 patients who underwent Roux-en-Y gastric bypass at the Palo Alto Veterans Affairs Medical Center from 2001 to 2007.
Dr. Ghiassi and his coinvestigators, Dr. John Morton and Dr. Dan Eisenberg (also of Stanford University), observed medication costs at 1 year after surgery, and compared them with presurgical medication costs. They calculated lifetime cost savings based on the Centers for Disease Control and Prevention life charts, with adjustments from the Framingham Heart Study survival statistics.
The patients were mostly men (77%). Their mean age was 52 years, and mean body mass index was 47 kg/m
At 1 year post surgery, the patients had lost a mean of 69% of their excess body weight. Hypertension had resolved in 44% and diabetes in 80%.
The projected lifetime cost of antihypertensive medication was $1,039 before surgery. For those whose hypertension resolved, that cost dropped significantly to $286. Savings were also evident in patients whose hypertension improved but did not resolve. Before surgery, the projected lifetime medication cost was $1,349. This decreased to $513.
There were no significant differences in age, BMI, or weight loss between these two groups of patients. However, patients who saw a resolution of hypertension lost significantly more excess body weight than those who saw only an improvement in hypertension (76% vs. 62%).
The projected lifetime cost of diabetes medication was $10,505. For those whose diabetes resolved completely, the projected lifetime cost decreased significantly, to $1,139. Savings were even greater in patients whose diabetes improved but did not resolve. For those patients, the projected lifetime cost of diabetes medication before surgery was $22,427. That dropped to $5,697 after surgery.
Several discussants commented on the study. Dr. Edward Felix, director of the Advanced Bariatric Center, Fresno, Calif., pointed out that the lifetime medication costs in the study “are far less than what we would see in just 1 year” of treating hypertension and diabetes in an obese population.
Dr. Phillip Schauer, a bariatric surgeon at the Cleveland Clinic, suggested that similar cost savings might be evident in other disorders comorbid with obesity. “These medication savings vastly underestimate the true cost savings of bariatric surgery,” he said. “You didn't look at other issues, like sleep apnea and dyslipidemia, which are also very costly. And the biggest cost savings is probably the reduction in complications of ineffectively treated diseases, like dialysis, coronary bypass surgery, and hip surgery.
“It's quite puzzling that, despite this overall evidence of cost benefit, most insurance carriers still don't cover bariatric surgery,” Dr. Schauer commented.
Disclosures: None of the investigators had any potential financial conflicts of interest.