Health Care Costs and Financing

Study examines national trends in the costs of bariatric surgery

Bariatric surgery is quickly emerging as the leading method of weight loss among the 5 percent of Americans who are morbidly obese (body mass index of 40 or more), with 11.5 million adult candidates for the surgery in 2002. The surgery can result in loss of 47 to 70 percent of pre-surgery weight. While the high demand for bariatric surgery is prompting insurance companies in some States to discontinue its coverage, many health plans are beginning to acknowledge the potential cost-savings of bariatric surgery, according to a study of national trends in the costs of bariatric surgery from 1998 through 2003.

Agency for Healthcare Research and Quality researchers, William E. Encinosa, Ph.D., Didem M. Bernard, Ph.D., and Claudia A. Steiner, M.D., M.P.H., analyzed data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project for 1998 and 2003. They found that from 1998 to 2003, the total number of bariatric surgeries increased by more than 740 percent from 13,386 to 112,435. In 2003, privately insured patients accounted for 82 percent of surgeries. Medicare, Medicaid, and self-pay accounted for 6, 5, and 3 percent of surgeries, respectively, with the remaining 3 percent of surgeries paid for by other payers.

National hospital costs for bariatric surgeries increased by more than 10 times from $173 million in 1998 to $1.74 billion in 2003, with the largest cost increase among the privately insured. Nationally, average hospital cost per bariatric surgery increased by 21 percent from $12,872 in 1998 to $15,533 in 2003, with the largest increase (27 percent) for Medicaid-covered surgeries. In 2003, high-volume hospitals (with at least 387 bariatric surgeries per year) had 3 times lower in-hospital deaths than low-volume hospitals (with fewer than 118 surgeries per year).

Long-term health benefits may outweigh the costs of bariatric surgery. One meta-analysis found that diabetes (for which care cost nearly $11,000 per person with diabetes in 2002) was resolved in 77 percent of patients who received bariatric surgery, cholesterol problems were improved in 70 percent, and hypertension was resolved in 62 percent.

See "National trends in the costs of bariatric surgery," by Drs. Encinosa, Bernard, and Steiner, in Bariatrics Today 3, pp. 10-12, 2005. Reprints (AHRQ Publication No. 06-R031) are available from The AHRQ Publication Clearinghouse.

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