Long Term Cost Outcomes Among Commercially Insured Patients Undergoing Bariatric Procedures.

Abstract Background: There has been a significant shift in the types of bariatric procedures being performed in the past decade, as procedures have become safer and less invasive, warranting a new data on long-term cost effectiveness. This study aims to examine the impact of bariatric procedures on a person’s long-term health care costs and compare how the impact differs by type of surgical procedure using 10-year data from 2009 -2018.Methods: This retrospective observational study compared the downstream health care cost of patients with obesity who had bariatric surgery to a matched nonsurgical cohort. Results: A total of 83 882 health plan enrollees who underwent bariatric surgery between January 2009 to December 2018, and a 1:1 matched group of health plan enrollees who were obese (body mass index≥30 kg/m2) but did not undergo bariatric surgery. The surgical group was associated with lower overall health care cost compared to the matched non-surgical group (cost ratios ranged 0.77 to 0.97, p values<.01). Lower costs were sustained during the initial six years following surgery. Majority of the cost savings came from reduced spending on prescription medications, particularly antidiabetics. However, the saving didn’t offset the initial surgery cost. Among the three most performed bariatric surgical procedures, sleeve gastrectomy was the most cost-effective.Conclusions: Post bariatric surgery cost savings have increased due to less complications and reduced medication spending, but the initial cost of bariatric surgery remains high than the savings incurred over years. This study provides recent economic data to inform policy makers and employers in designing benefits for bariatric procedures.