Two Analyses Show Cost-Benefit for Bariatric Surgery -- MEDICA - World Forum for Medicine

In two separate studies, the authors estimate the return on investment associated with an employer’s decision to provide some level of coverage for bariatric surgery and the demand for such surgeries based on various out-of-pocket costs. The most common forms of the procedure are gastric banding and gastric bypass, which cost about $15,000 and $25,000, respectively, in total medical costs, which include surgery, hospitalisation and recovery.

In the first paper, the authors used nationally representative data to determine that roughly nine percent of all full-time employees are eligible for bariatric surgery based on existing guidelines. Because of their high medical costs and increased absenteeism, approximately two-thirds of costs attributable to obesity (roughly $90 billion per year) are incurred by those eligible for bariatric surgery.

Based on the simulation models, the authors determined it would likely take between five and ten years for an employer to recover the full cost of the surgery, although higher cost-sharing could reduce the break-even point to less than five years.

In the second study, RTI researchers and colleagues used an Internet survey of obese individuals to determine that about 150,000 bariatric procedures per year would be demanded by those with private health insurance at an out-of-pocket price of $25,000.

Decreasing the out-of-pocket cost from $25,000 to $10,000 would result in only a small increase in the total number of surgeries demanded. Even when fully covered by insurance, the results suggest that demand among those with private insurance would not exceed about 375,000 procedures per year among full time employees.

"On the one hand, the time to break even may be longer than some have suspected," lead author Eric Finkelstein said. "On the other hand, the demand for the surgery appears less than many have anticipated."; Source: RTI International