Surgery, Suffering, and Money in Obesity and Diabetes

Does gastric bypass surgery save money for patients with obesity and diabetes? That’s the question a new study answers in Obesity this week. Suffering with a chronic disease – at least in the short term – is usually free. So finding savings would indeed be surprising in a two-year study such as this one. This study holds no such surprise. Senior author David Arterburn explains:

The clinical benefits of bariatric surgery for these patients are indisputable. But it doesn’t save money. And we shouldn’t require obesity treatment to be cost saving.

We don’t hold most other treatments to such a standard (e.g., care for cancer or heart disease care). Obesity treatments should be cost effective. That is, they should provide good value (in terms of health improvements) for money. And a solid body of evidence supports the cost effectiveness of obesity treatments, especially bariatric surgery and intensive lifestyle interventions (e.g., DPP).

Saving Money with Surgery?

Expecting surgery to save money is an especially harsh demand. Surgery restores life and normal functions. But it seldom saves money.

Take the case of someone with a fractured arm near their shoulder. (We know this person.) Without immediate care, which may include surgery, this person faces a great deal of pain. He will likely lose full movement in his shoulder. But the surgery costs tens of thousands of dollars and suffering is free. Does surgery save money? No. Is it cost effective? Yes.

Both the suffering and the complications of obesity and diabetes are spread out over many years. Heart disease develops, kidneys fail, and the complications multiply. The cost of a foot amputation can exceed the cost of bariatric surgery, but that cost comes many years after bariatric surgery could have helped.

The Bottom Line

At a cost of approximately $25,000, bariatric surgery is not an especially expensive procedure. It can be life saving and life changing. For putting diabetes into remission, it is far more effective than any other treatment.

But it won’t save money for a health plan. We should never expect it to.

Click here for the study, here for more perspective on the cost effectiveness of bariatric surgery, and here for a broader perspective on the cost effectiveness of common surgeries.

Apple, Orange, and Lemon. Photograph © zaphad1 / flickr

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July 20, 2017