Study Questions Cost Savings of Weight-Loss Surgery (About Time)
TRIGGER WARNING: Weight loss surgery talk ahead.
Well, well, well, it’s about damned time someone did a study on the cost savings of WLS and here it is. There are some conclusions drawn, toward the end of the article with which I do not agree, but we’ll get to that in a bit.
Bariatric surgery did not reduce healthcare costs over the long term when surgery patients were compared with matched obese patients who did not have surgery, a review of almost 30,000 cases showed.
Right, because everyone knows that being fat raises health care costs over the moon, is bankrupting our country, and making health care more expensive for everyone (/sarcasm).
Surgical patients had lower healthcare costs in the first year after surgery, averaging about $1,000 lower per case, according to Jonathan P. Weiner, DrPH, of the Johns Hopkins School of Public Health, and co-authors. During the next 2 years, bariatric surgery was associated with significantly higher healthcare costs. In years 4 through 6, costs stabilized but remained higher in the surgery cohort for 2 of the 3 years.
“Bariatric surgery does not reduce overall healthcare costs in the long term,” the authors concluded. “Also, there is no evidence that any one type of surgery is more likely to reduce long-term healthcare costs.
The medical profession has been doing bariatric surgery of one sort or another on fat people for over 40 years and they’re just now looking at whether it actually saves money in the long run? After all these years of saying that the costs of obesity are skyrocketing and “we need to do something to curb them immediately,” you’re just now looking into whether it’s actually cost effective? Really?
“To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.”
As evidence has accumulated to support the health benefits of bariatric surgery, the number of procedures has increased dramatically, reaching 220,000 annually as of 2009. Additionally, numerous studies have suggested that bariatric surgery reduces healthcare costs by improving patients’ health and well-being.
Future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings. Excuse me while I catch my breath, I’m laughing so hard at this one. Like the complications from all kinds of WLS have never been documented and no one (in the medical profession) knows how debilitating those complications can be, or how they impact their patients’ health or quality of life. (sarcasm)Yep, surgeons and doctors don’t know any of that and they need studies to tell them that information. Because “everyone knows” that being fat is going to “cause” all kinds of VFHTs and fat people will die if they don’t get thin (and really, who gives a shit if they die from the surgery that’s supposed to end those VFHTs and make them thin?). (/sarcasm)
Fuck you very much, asshats. What future studies should concentrate on is whether those health “improvements” that are supposed to happen after WLS actually do happen and if they’re actually sustained for life (because we know the weight loss sure as hell isn’t sustained in most cases). And do those health “improvements” come at the cost of quality of life — is it really worth it to be thin if you’re malnourished, vomiting after every meal, losing hair, restricted on the types/textures of foods you can eat, have neurological problems, etc?
In particular, laparoscopic bariatric procedures have won favor because of their association with shorter hospital stays and fewer complication rates as compared with open procedures. However, questions have persisted about the potential return on investment, the most cost-efficient surgical procedures, and whether cost savings are sustained over time.
Fewer complications? Really? Ask all the patients who have lapbands how few complications they have and whether those complications have an adverse impact on their lives. Like band problems, blood clots, bowel function changes, bowel perforations, esophageal dilation, food trapping, gallstones, gastroesophageal reflux disease (GERD), hiatal hernia, indigestion (dyspepsia), intolerance to certain foods, nausea and vomiting, pneumonia, port problems, and pouch dilation are just a snap to deal with and no big deal (oh, and it doesn’t cost any more money to deal with these complications than it would to deal with being fat either, amirite?).
I’m not even getting into the complications that surround WLS other than lapband, I’ve listed them before and they’re more extensive and more debilitating, in a lot of cases, than the complications from lapbanding. So yeah, by all means, look at the cost “savings” of WLS over treating the diseases “caused” by being fat. I’m not holding my breath waiting for y’all to tell me that WLS just saves tons of money.
To address some of the unresolved issues, Weiner and colleagues analyzed claims data provided by seven Blue Cross/Blue Shield healthcare plans with total enrollment of 18 million. The authors identified 29,820 plan members who underwent bariatric surgery during 2002 through 2008. Each patient was matched with another plan member who had one or more diagnoses associated with obesity but did not have weight-loss surgery.
The two groups had comparable healthcare costs in the year prior to date of the surgical patients’ procedures: $8,850 in the surgical cohort and $9,590 for the comparison group. The standardized cost of surgery was $29,517, including the surgery and 30-day follow-up period.
In the first year after surgery, healthcare costs averaged $8,905 in the surgery cohort and $9,908 in the comparison group. During year 2, total healthcare costs in the surgical cohort peaked at $9,908, whereas costs in the comparison group decreased to $9,264. Costs in the surgery cohort exceeded those of the comparison group for 3 of the next 4 years:
Year 3 — $9,211 versus $9,041
Year 4 — $9,051 versus $9,232
Year 5 — $9,386 versus $8,966
Year 6 — $9,259 versus $8,714
Bariatric surgery patients had lower costs for prescriptions and clinic visits but higher costs for inpatient care compared with the comparison group.
And this just covers the costs paid out by the insurance company. It doesn’t look at out-of-pocket costs incurred and paid for by patients (and believe me, those supplements that WLS survivors end up taking to just have some semblance of “health” are not cheap). Does this make anyone else wonder what the costs would be if they looked at them 10 years out, 15 years out, 20 years out? I’m thinking they don’t get less, and probably get much higher as time goes on.
In a critique of the study, JAMA deputy editor Edward H. Livingston, MD, said bariatric surgery clearly benefits a subgroup of patients who have a complication or condition known to improve dramatically with weight loss, such as diabetes and osteoarthritis. Reducing body mass index should not be the exclusive indication for the surgery.
Right, because WLS “cures” type 2 diabetes. It doesn’t, it puts T2D into remission for a period of time, and then blood glucose starts to rise again because WLS doesn’t deal with the underlying cause of T2D — the body’s inability to use glucose properly.
And we all know that only fat people get arthritis and the only way to “cure” it is to become less fat (excuse me while I LMFAO over this one). Why in the hell do doctors think WLS is going to “cure” a disease in fat people, but don’t recommend that same “cure” for those thin people who have the same fucking disease? I mean, if it’s a “cure” for the disease, shouldn’t everyone be lining up for it? (I’m not even getting into the stupidity of the rationale behind “but fat is going to kill you, it’s for your own good”.)
“Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive,” Livingston wrote. “In this era of tight finances and inevitable rationing of healthcare resources, bariatric surgery should be viewed as an expensive resource that can help some patients.
“Those patients should be carefully vetted and the operations offered only if there is an overwhelming probability of long-term success.”
“Bariatric surgery has dramatic short-term results, but on a population level, its outcomes are far less impressive,” Livingston wrote. Ya think? Dramatic short-term weight loss followed by debilitating complications and weight regain are “far less than impressive” outcomes. Do tell, Dr Livingston, do fucking tell.
As for that “overwhelming probability of long-term success”? Why don’t you hold your breath waiting for that to happen? If we’re lucky, you’ll turn blue and pass out (and maybe that will enlighten you to the fact that “it ain’t happening, dude.”).
The findings are informative but do not necessarily reflect the current practices and economics of bariatric surgery, according to Jaime Ponce, MD, president of the American Society of Metabolic and Bariatric Surgery. In particular, the study reflected a predominance of open procedures, even in the last year of the study period. Since that time, laparoscopic procedures have become predominant.
“We know that open surgery requires a longer follow-up to see the economic benefits of bariatric surgery,” said Ponce, of Memorial Hospital in Chattanooga, Tenn. “Even in the last year of the study, a large number of open surgeries were performed. Today about 90% of bariatric surgery procedures are performed laparoscopically.”
Right, Dr Ponce, and those complications of lapband that I listed earlier — were the result of laparascopic lapbanding. But I suppose those complications aren’t expensive to deal with, so costs aren’t a factor? Yeah, right.
The following statement is the one that really pisses me off and I’ll explain why, after you read the comment.
Ponce also noted that the study did not take into account the economic impact of the indirect benefits of bariatric surgery, such as improved employability, improvement in overall health, resolution of diabetes and other metabolic disturbances, and better quality of life.
Improved employability? WTfuckingF? Fat people need to change because employers are such bigoted asshats that they think we can’t do the job? Fuck you, Dr. Ponce, marginalized groups do not have to change to meet some “ideal” in order to have the rights that everyone else has.
Improvement in overall health? Yeah, those complications are an improvement all right, in spite of the increased costs of health care after WLS.
Resolution of diabetes and other metabolic disturbances? Yeah, for a short period of time, and then you end up treating those diseases all over again.
Better quality of life? Right, living with complications like vomiting, GERD, chronic diarrhea/constipation, etc. is just such a wonderful improvement of one’s quality of life.
What fucking world are you living in, Dr. Ponce? The evidence is out there, but it doesn’t gibe with what the medical community has been recommending to fat people for over 50 years now, so you’re putting your fingers in your ears and only hearing what you want to hear, which isn’t that this is a horrible solution to a problem that doesn’t fucking exist.
I have a suggestion for all the doctors who think that WLS is the solution — try looking at your fat patients as people first, treating their problems the same way you’d treat the same problems in a thinner person, and STFU about WLS. That would go a very long way toward improving the lives of your fat patients.