Bariatric Surgery, a Growth Market, Quadruples in Five Years
By Katrina Woznicki, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
July 13, 2005
Source News Article: Forbes, MSNBC
MedPage Today Action Points
Be aware that as the obesity epidemic continues to rise in the United States, so too could the number of candidates for bariatric surgery. To be eligible for bariatric surgery, patients must have a body mass index of 40 or higher.
Discuss with patients who may be candidates for bariatric surgery the potential risks associated with the procedure. This study found that from 1998 to 2002, patient outcomes improved and the death rate declined.
This report found that prescription weight loss medications, particularly Xenical (orlistat) and Meridia (sibuatramine) are popular, but patients often do not use them beyond approximately 100 days, suggesting the side effects of these drugs may impact adherence.
Review
ROCKVILLE, Md., July 13-The number of gastric bypass and related procedures performed per year swelled by more than 400% from 1998 until 2002 while hospital costs for bariatric surgery ballooned sixfold.
Of the 11.5 million obese adults eligible for bariatric surgery in 2002, meaning a body mass index of 40 or more, 0.6% (71,733 patients) underwent a gastric bypass or related procedure, reported economist William Encinosa, Ph.D., and colleagues of the Agency for Healthcare Research and Quality. That compared with 13,386 procedures in 1998.
The findings, published in the July 12 issue of Health Affairs, also showed that as gastric bypasses and related hospitals costs climbed, inpatient mortality dropped 64%. While women overall accounted for 84% of the procedures, men had a higher hospital mortality rate compared with women in comparable age groups.
The findings suggested that the popularity of bariatric surgery and the increasing perception that it is safe and effective show no signs of abating.
"As bariatric surgeons perform more surgeries and outcomes continue to improve, it is likely that more people will opt for the surgery," Dr. Encinosa and colleagues wrote.
The findings were based on data from the Nationwide Inpatient Sample of the Healthcare Costs and Utilization Project for 1998 and 2002 and Medstat 2002 Marketscan Commercial Claims and Encounter Database.
Gastric bypass, most prominently the Roux-en-Y procedure, can help patients achieve up to a 70.1% weight loss, potentially resulting in an 89% decreased relative risk of premature death, the investigators wrote.
Among the report's findings:
A total of 13,386 bariatric procedures were performed in 1998. That number jumped to 71,733 in 2002, resulting in a 436% increase.
Hospital costs for bariatric procedures rose from $157 million in 1998 to $948 million in 2002, a 503% increase.
The average cost per procedure was $11,705 in 1998. That figure rose by 12.9% in 2002 to $13,215 per operation.
In 2002, patients ages 18-54 accounted for 88 percent of all surgeries, while the near-elderly (ages 55-64) accounted for 11 percent. However, the near elderly had the fastest growth in bariatric operations. A 10-fold increase occurred between 1998 and 2002, with 771 bariatric procedures performed in 1998 on those ages 55 to 64, compared with 7,719 procedures in 2002.
Those ages 65 to 69 could potentially account for a larger portion of the bariatric surgery patient population in the coming five years. The researchers estimated that 395,000 people ages 65 to 69 are eligible for bariatric surgery this year. By 2010, that figure could jump to 475,000.
Overall, length of hospital stays dropped 24% during the five years and inpatient death declined 64% from 0.89% to 0.32%. Length of hospital stay and increased risk of death generally increased with age.
While inpatient death declined for men from 1998 to 2002 (2.76% to 0.79%, respectively), their rates remained higher than women's for 2002 (0.79% and 0.24%, respectively). This may be attributable to "higher coexisting illnesses or higher body mass index (among men) at the time of surgery," the researchers wrote.
Gastric bypass Roux-en-Y accounted for 84.7% of the bariatric procedures performed in 2002.
The report also examined the 2002 use of prescription weight-loss medications, which regained popularity in the late 1990s with the 1999 market introduction of Xenical (orlistat), a lipase inhibitor. The researchers found that in 2002, patients spent an average of $304 per person on weight loss medications, with 74% covered by their health plans. Patients are often eligible for coverage of prescription weight loss medications if they have a BMI of 30 or higher.
Weight loss drugs like Xenical and Meridia (sibutramine), an appetite suppressant, were widely used, with 9,827 patients reporting taking Xenical in 2002 and 6,376 patients reporting taking Meridia. However, the average number of days these drugs were used was short, 110 days and 102 days, respectively. "This may suggest the discomfort of side effects reduces adherence," the authors said.
Men used weight loss drugs longer than women and spent more money on them, 122 days versus 117 days per year, and $327 versus $297 per year, respectively.
Related articles:
ASBS: Bariatric Surgery's Cardiovascular Benefits Exceed Assumptions
Experience Counts for Laparoscopic Gastric Bypass Surgery
Primary source: Health Affairs
Source reference:
Encinosa et al, "Use and Costs of Bariatric Surgery And Prescription Weight-Loss Medications," Health Affairs, July/August 2005; vol. 24; No. 4; p.1039-1046
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