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Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass.

Publication ,  Journal Article
Lewis, KH; Zhang, F; Arterburn, DE; Ross-Degnan, D; Gillman, MW; Wharam, JF
Published in: JAMA Surg
August 2015

IMPORTANCE: There is conflicting evidence about how different bariatric procedures impact health care use. OBJECTIVE: To compare the impact of laparoscopic adjustable gastric banding (AGB) and laparoscopic Roux-en-Y gastric bypass (RYGB) on health care use and costs. DESIGN, SETTING, AND PARTICIPANTS: Retrospective interrupted time series with comparison series study using a national claims data set. The data analysis was initiated in September 2011 and completed in January 2015. We identified bariatric surgery patients aged 18 to 64 years who underwent a first AGB or RYGB between 2005 and 2011. We propensity score matched 4935 AGB to 4935 RYGB patients according to baseline age group, sex, race/ethnicity, socioeconomic variables, comorbidities, year of procedure and baseline costs, emergency department (ED) visits, and hospital days. Median postoperative follow-up time was 2.5 years. MAIN OUTCOMES AND MEASURES: Quarterly and yearly total health care costs, ED visits, hospital days, and prescription drug costs. We used segmented regression to compare pre-to-post changes in level and trend of these measures in the AGB vs the RYGB groups and difference-in-differences analysis to estimate the magnitude of difference by year. RESULTS: Both AGB and RYGB were associated with downward trends in costs; however, by year 3, AGB patients had total annual costs that were 16% higher than RYGB patients (P < .001; absolute change: $818; 95% CI, $278 to $1357). In postoperative years 1 and 2, AGB was associated with 27% to 29% fewer ED visits than RYGB (P < .001; absolute changes: -0.6; 95% CI, -0.9 to -0.4 and -0.4; 95% CI, -0.6 to -0.1 visits/person, respectively); however, by year 3, there were no detectable differences. Postoperative annual hospital days were not significantly different between the groups. Although both procedures lowered prescription costs, annual postoperative prescription costs were 17% to 32% higher for AGB patients than RYGB patients (P < .001). CONCLUSIONS AND RELEVANCE: Both laparoscopic AGB and RYGB were associated with flattened total health care cost trajectories but RYGB patients experienced lower total and prescription costs by 3 years postsurgery. On the other hand, RYGB was associated with increased ED visits in the 2 years after surgery. Clinicians and policymakers should weigh such differences in use and costs when making recommendations or shaping regulatory guidance about these procedures.

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Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

August 2015

Volume

150

Issue

8

Start / End Page

787 / 794

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Propensity Score
  • Patient Acceptance of Health Care
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Laparoscopy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lewis, K. H., Zhang, F., Arterburn, D. E., Ross-Degnan, D., Gillman, M. W., & Wharam, J. F. (2015). Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg, 150(8), 787–794. https://doi.org/10.1001/jamasurg.2015.1081
Lewis, Kristina H., Fang Zhang, David E. Arterburn, Dennis Ross-Degnan, Matthew W. Gillman, and J Frank Wharam. “Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass.JAMA Surg 150, no. 8 (August 2015): 787–94. https://doi.org/10.1001/jamasurg.2015.1081.
Lewis KH, Zhang F, Arterburn DE, Ross-Degnan D, Gillman MW, Wharam JF. Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg. 2015 Aug;150(8):787–94.
Lewis, Kristina H., et al. “Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass.JAMA Surg, vol. 150, no. 8, Aug. 2015, pp. 787–94. Pubmed, doi:10.1001/jamasurg.2015.1081.
Lewis KH, Zhang F, Arterburn DE, Ross-Degnan D, Gillman MW, Wharam JF. Comparing Medical Costs and Use After Laparoscopic Adjustable Gastric Banding and Roux-en-Y Gastric Bypass. JAMA Surg. 2015 Aug;150(8):787–794.

Published In

JAMA Surg

DOI

EISSN

2168-6262

Publication Date

August 2015

Volume

150

Issue

8

Start / End Page

787 / 794

Location

United States

Related Subject Headings

  • Young Adult
  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Propensity Score
  • Patient Acceptance of Health Care
  • Obesity, Morbid
  • Middle Aged
  • Male
  • Laparoscopy