Clinical Decisionmaking

AHRQ study finds weight-loss surgeries quadrupled in 5 years

The number of Americans having weight-loss surgery more than quadrupled between 1998 and 2002—from 13,386 to 71,733—with part of the increase driven by a 900 percent rise in operations on patients between the ages of 55 and 64, according to a new study from the Agency for Healthcare Research and Quality. The study was led by William Encinosa, Ph.D., of AHRQ's Center for Delivery, Organization, and Markets.

During the same period, hospital costs for treating patients who underwent weight-loss surgery increased by more than six times—from $157 million a year to $948 million a year—and the average cost per surgery increased by roughly 13 percent, from $11,705 to $13,215.

To be considered medically eligible for weight-loss surgery, known technically as bariatric surgery, a patient must have a body mass index greater than 40 (or greater than 35 with serious obesity-related complications such as type 2 diabetes or obstructive sleep apnea). Approximately 395,000 Americans between 65 and 69 years of age will be medically eligible to have weight-loss surgery this year, and this number could increase by approximately 20 percent, to 475,000, by 2010. Such an increase would have important cost implications for the Medicare program, according to Dr. Encinosa and his colleagues.

The researchers estimate that future demand for weight-loss surgery could rise even more sharply as safety concerns diminish. To date, only a small fraction of people who are medically eligible for weight-loss surgery have actually had the procedure. In 2002, for example, only 0.6 percent of an estimated 11.5 million morbidly obese patients underwent weight-loss surgery. Meanwhile, in-hospital death rates among weight-loss surgery patients as a whole fell by 64 percent-from 0.89 percent to 0.32 percent between 1998 and 2002. In spite of the overall decline, the death rate for men, which dropped from 2.76 percent to 0.79 percent, was still three times as high as it was for women (0.24 percent).

The authors further suggest that future use and costs of prescription weight-loss drugs also could increase significantly. Although 63 million Americans were medically eligible for weight-loss drugs in 2002, less than 2.4 percent actually received prescriptions for these drugs. The average spending on weight-loss drugs in 2002 was $304 per patient, with health plans paying roughly three-fourths of the expense and patients paying the balance. According to Dr. Encinosa and his colleagues, newer, more effective drugs now under development to block cravings or appetite will likely increase the demand for prescription weight-loss medications.

The authors based their estimates on data from the Nationwide Inpatient Sample, a database of the Healthcare Cost and Utilization Project sponsored by AHRQ in partnership with data organizations in 37 States. The Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States from which national estimates of inpatient care can be derived.

Data are also from the Medstat 2002 MarketScan Commercial Claims and Encounter Database. The MarketScan database contains claims for inpatient hospital care, outpatient care, and prescription drugs for enrollees under age 65 in employer-sponsored benefit plans for 45 large employers across the United States.

For more details, see "Use and costs of bariatric surgery and prescription weight-loss medications," by Dr. Encinosa, Didem M. Bernard, Ph.D., Claudia A. Steiner, M.D., M.P.H., and Chi-Chang Chen, Ph.D., in the July 12, 2005, Health Affairs 24(4), pp. 1039-1046. Reprints (AHRQ Publication No. 05-R059) are available from the AHRQ Publications Clearinghouse.

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