INDIANAPOLIS (AP) - Bariatric surgery can pay for itself in a few years by helping to reduce insurance claims from other medical conditions morbidly obese people develop, a new study reports.
Insurers can recover the surgery cost, which ranges between $17,000 and $26,000, in two to four years, said a study published recently in The American Journal of Managed Care.
The study was funded by Johnson & Johnson's Ethicon Endo-Surgery Inc., which makes bariatric surgical instruments. But lead author Pierre-Yves Cremieux said he devised the study before Ethicon offered to fund it, and the company had no influence on the research.
Co-author Dr. Scott Shikora is president of the American Society for Metabolic and Bariatric Surgery, whose members would stand to gain from any easing of insurers' requirements for the surgery.
Researchers compared insurance claims for more than 3,600 patients who had the surgery with those filed by the same number of morbidly obese people who did not.
Among the patients who had surgery, the percentage with diabetes, hypertension or sleep apnea all decreased after the operation. Percentages for those conditions either stayed the same or rose in the patient group that didn't have surgery, according to the study, which was funded by a company that makes bariatric surgery equipment.
Monthly medical costs for patients who had laparoscopic bariatric surgery were as much as $900 lower than those who did not roughly a year after the operation, according to the study.
“Bariatric surgery is a unique field in that with one operation you can cure a wide range of different health conditions,” Shikora said. “This paper demonstrated that you can do that and actually save money in the process.”
Bariatric surgery aims to produce significant weight loss and often involves an operation on the stomach or intestines. An estimated 220,000 procedures will be performed this year, a more-than-tenfold increase since 1992, according to the American Society for Metabolic and Bariatric Surgery.
He said insurers generally cover bariatric surgery. But he thinks they add obstacles to avoid covering the expensive procedure.
Many require a six-month, doctor-supervised weight-loss program before the operation, even though most patients have already tried “every diet and every pill and every weight loss program out there,” Shikora said.
“Obesity is a disease, it's not just a choice or an eating affliction,” he said. “It is a genetic disease, and I don't feel that the morbidly obese patient should be treated any differently than a patient with breast cancer, or HIV or other ailments.”
Cost is a factor for insurers, said Susan Pisano, a spokeswoman for the trade association America's Health Insurance Plans. But she said their main concerns focus on safety and quality issues like the experience of surgeons performing the procedure.
The risk of death from weight loss surgery has fallen below 1 percent in recent years, Shikora said.
Pisano also said the industry has been concerned about the surgery being performed on patients who don't meet National Institutes of Health guidelines for it.
“I think there has been concern about this being sort of the first option and a silver bullet ... as opposed to it having a place in the treatment of morbid obesity,” she said.
Nevertheless, she said the insurance industry would consider this study, but she noted that it is one study.
