A new study models an improved bariatric surgery care pathway to estimate the cost-effectiveness of bariatric surgery.
For many obese patients, surgery is a key treatment option that can provide long-term health improvement. Evidence over the years has established the positive outcomes of bariatric surgery in suitable patients. Bariatric surgery has been associated with better weight-loss maintenance and better control (or resolution) of other medical conditions, including type 2 diabetes, high blood pressure, and high cholesterol. Despite these benefits, however, there are barriers to accessing bariatric surgery, especially in publicly funded healthcare systems, such as Canada.
Bariatric surgery and care in Canada are covered by the public healthcare system. However, inefficiencies within the system and other barriers, such as patient perception, contribute to its underuse. A recent study uses analytical models to estimate the cost-effectiveness of bariatric surgery in Canada to determine whether the healthcare system could benefit from an improved delivery of care for patients eligible for bariatric surgery.
The study used published Canadian clinical data (and supplemental American data when Canadian data was unavailable) to analyse, model, and evaluate the economic impact of an improved bariatric surgery care pathway. The researchers generalized potential outcomes from published data from previous studies. Parameters used to estimate trajectories included waiting time to surgery, weight loss outcomes, and improvement or resolution of comorbid conditions.
The study found that the current care pathway for bariatric surgery patients is poor. The lengthy wait times meant that patients were more likely to withdraw from the program and those that remained had poor weight loss trajectory outcomes. The researchers concluded that if surgery wait times could be reduced and weight loss trajectories could be improved to sustain weight loss, these patients could reduce the patient-years of treatment for other comorbid conditions, such as diabetes, high cholesterol, and high blood pressure. These would translate to savings to the public payer.
Since the study results are based on modelled trajectories based on previously published clinical data, their conclusions regarding healthcare improvements are only hypothetical. Nonetheless, the estimated cost-effectiveness of bariatric surgery could be the starting point for discussions to improve delivery of bariatric surgical care to Canadians.
Written by Maggie Leung, PharmD
Davis, J. A., & Saunders, R. (2020). Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada. JAMA Network Open, 3(1). doi: 10.1001/jamanetworkopen.2019.19545
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