Health Expenditures After Bariatric Surgery: A Retrospective Cohort Study.

OBJECTIVE: To compare expenditures between surgical and matched nonsurgical patients in a retrospective cohort study. BACKGROUND: Bariatric surgery leads to substantial improvements in weight and weight-related conditions, but prior literature on postsurgical health expenditures is equivocal. METHODS: In a retrospective study, total outpatient, inpatient, and medication expenditures 3 years before and 5.5 years after surgery were compared between 22,698 bariatric surgery [n = 7127 Roux-en-Y gastric bypass (RYGB), 15,571 sleeve gastrectomy (SG)] patients from 2012 to 2019 and 66,769 matched nonsurgical patients, using generalized estimating equations. We also compared expenditures between patients receiving the 2 leading surgical procedures in weighted analyses. RESULTS: Surgical and nonsurgical cohorts were well matched, 80% to 81% females, with mean body mass index of 44 and mean age of 47 (RYGB) and 44 (SG) years. Estimated total expenditures were similar between surgical and nonsurgical groups 3 years before surgery ($27 difference, 95% CI: -42, 102), increased 6 months before surgery for surgical patients, and decreased below preperiod levels for both groups after 3 to 5.5 years to become similar (difference at 5.5 years = -$61, 95% CI: -166, 52). Long-term outpatient expenditures were similar between groups. Surgical patients' lower long-term medication expenditures ($314 lower at 5.5 years, 95% CI: -419, -208) were offset by a higher risk of hospitalization. Total expenditures were similar between patients undergoing RYGB and SG 3.5 to 5.5 years after surgery. CONCLUSIONS: Bariatric surgery translated into lower medication expenditures than matched controls, but not lower overall long-term expenditures. Expenditure trends appear similar for the two leading bariatric operations.

Duke Scholars

Author Caroline Sloan Medicine, General Internal Medicine

Author Valerie A. Smith Population Health Sciences

Author Matthew Leonard Maciejewski Population Health Sciences