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Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.

Publication ,  Journal Article
Lewis, KH; Argetsinger, S; Arterburn, DE; Clemenzi, J; Zhang, F; Kamusiime, R; Fernandez, A; Ross-Degnan, D; Wharam, JF
Published in: JAMA Netw Open
May 2, 2022

IMPORTANCE: Studies comparing contemporary bariatric surgical types could facilitate procedure selection for patients interested in reducing their frequency of health care visits and reliance on prescription drugs. OBJECTIVE: To compare the association of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with ambulatory health care costs and use for as long as 4 years after surgery. DESIGN, SETTING, AND PARTICIPANTS: This comparative effectiveness study, which included patients undergoing bariatric surgery who were aged 18 to 64 years with at least 24 months of enrollment data before surgery and 12 months of enrollment data after surgery, used a retrospective interrupted time series with a comparison group. Data represent insurance claims dated January 2006 to June 2017, with analyses completed in September 2021. Data were collected from US commercial and Medicare Advantage claims database. Cohorts were matched on characteristics including baseline body mass index category, diabetes status, baseline ambulatory care costs, region of the United States, and year of surgery. EXPOSURES: SG or RYGB, based on procedure codes. MAIN OUTCOMES AND MEASURES: Annual ambulatory health care costs, and subtypes of cost and use including prescriptions, office visits, laboratory encounters, and radiology. RESULTS: Matched cohorts included 3049 patients who underwent SG and 3251 patients who underwent RYGB, with a mean (SD) age of 45.2 (10.0) years; 4820 (77%) were women. Full follow-up was 37% for SG (514 patients) and 38% for RYGB (643 patients) among those eligible for 4-year follow-up. There were no significant differences between SG and RYGB in total ambulatory costs, office visit costs, or radiology costs in all follow-up years. Patients who underwent SG had significantly higher prescription costs than those who underwent RYGB bypass in year 4 ($852.8 per patient per year; 95% CI: $395.6-$1310.0 per patient per year) with more cardiometabolic medication fills in each year (eg, year 4: 42.5%; 95% CI, 13.7%-71.2%). In contrast, early after surgery, patients who underwent SG had relatively fewer specialist visits (eg, year 1: -7.2%; 95% CI, -14.3% to -0.2%) and lower laboratory costs (eg, year 1: -$118.9 per patient per year; 95% CI, -$220.2 to -$17.5 per patient per year). CONCLUSIONS AND RELEVANCE: Despite clinical studies showing greater weight loss and comorbidity improvement with RYGB vs SG, this study found no difference in total ambulatory costs for as long as 4 years after SG and RYGB. These findings may reflect the trade-off between greater improvements in cardiometabolic health and additional surgery-related care among patients undergoing RYGB. Studies with longer follow-up time could determine whether greater sustained weight loss from RYGB eventually results in lower costs compared with SG.

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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

May 2, 2022

Volume

5

Issue

5

Start / End Page

e229661

Location

United States

Related Subject Headings

  • Weight Loss
  • United States
  • Retrospective Studies
  • Obesity, Morbid
  • Medicare
  • Male
  • Humans
  • Health Care Costs
  • Gastric Bypass
  • Gastrectomy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Lewis, K. H., Argetsinger, S., Arterburn, D. E., Clemenzi, J., Zhang, F., Kamusiime, R., … Wharam, J. F. (2022). Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. JAMA Netw Open, 5(5), e229661. https://doi.org/10.1001/jamanetworkopen.2022.9661
Lewis, Kristina H., Stephanie Argetsinger, David E. Arterburn, Jenna Clemenzi, Fang Zhang, Ronald Kamusiime, Adolfo Fernandez, Dennis Ross-Degnan, and James F. Wharam. “Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.JAMA Netw Open 5, no. 5 (May 2, 2022): e229661. https://doi.org/10.1001/jamanetworkopen.2022.9661.
Lewis KH, Argetsinger S, Arterburn DE, Clemenzi J, Zhang F, Kamusiime R, et al. Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. JAMA Netw Open. 2022 May 2;5(5):e229661.
Lewis, Kristina H., et al. “Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.JAMA Netw Open, vol. 5, no. 5, May 2022, p. e229661. Pubmed, doi:10.1001/jamanetworkopen.2022.9661.
Lewis KH, Argetsinger S, Arterburn DE, Clemenzi J, Zhang F, Kamusiime R, Fernandez A, Ross-Degnan D, Wharam JF. Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy. JAMA Netw Open. 2022 May 2;5(5):e229661.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

May 2, 2022

Volume

5

Issue

5

Start / End Page

e229661

Location

United States

Related Subject Headings

  • Weight Loss
  • United States
  • Retrospective Studies
  • Obesity, Morbid
  • Medicare
  • Male
  • Humans
  • Health Care Costs
  • Gastric Bypass
  • Gastrectomy