The number of US residents undergoing surgery for weight loss more than quadrupled between 1998 and 2002—from 13 386 to 71 733. Part of the increase was due to a 900% increase in operations on patients aged 55-64, says the first national estimate based on hospital and insurance claims data (Health Affairs 2005;24:1039-46).
In the same period, hospital costs for bariatric surgery increased more than sixfold, from $157m (£90m; €131m) to $948m a year. The average cost per surgery increased by roughly 13%, from $11 705 to $13 215, says the study from the Agency for Healthcare Research and Quality. The largest increase in average costs was for surgery covered Medicaid (17.7%), despite a decline in length of stay from 5.8 days to 4.9 days.
Bariatric surgery is one of the fastest growing surgical procedures in the United States. It involves restricting the size of the stomach and bypassing parts of the intestines to reduce the absorption of food. Prescription drugs for weight loss either reduce the absorption of fat or suppress appetite. Orlistat (Xenical), which blocks about a third of ingested fat, was the third most heavily advertised drug in 1999, with $76m spent on advertising to consumers.
Both bariatric surgeries and drugs are claimed to have substantial benefits. “A recent meta-analysis found that the percentage of excess weight loss was 61.6-70.1% with gastric bypass, the most common bariatric surgery,” says the study. “As a result, diabetes was completely resolved in 76.8% of patients. Another recent study found that gastric bypass patients had an 89% reduced relative risk of death.”
Bariatric surgery is recommended only for morbidly obese persons with a body mass index of 40 or more, but bariatric drug therapy is recommended for obese people with an index of 30 or more. The study authors say that a recent meta-analysis found that bariatric drugs result in a net weight loss of less than 4.5 kg (over the placebo) after a year, but this might still be clinically significant in reducing diabetes and high blood pressure.
Total US sales of such drugs in 2002 were $362m. In that year, an estimated 63.3 million US adults were clinically eligible for them, but they were used by fewer than 2.4% of those eligible. Only a small fraction of those medically eligible for bariatric surgery also actually had it. Given the number of new more effective drugs being developed, and the increasing safety of bariatric surgery, usage of both treatments could greatly increase, with important implications for Medicare, say the authors.
Study data came from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, involving about 1000 hospitals, and the Medstat 2002 MarketScan commercial claims and encounter database. The latter involved claims covering 5.6 million people from benefit plans of 45 large employers across the country.