Unveiling the cost-effectiveness of bariatric surgery: insights from a matched cohort study

Abstract

Background Obesity is a global health problem with alarming rates of morbidity and mortality. Although bariatric surgery is a proven safe and effective treatment for obesity, only a small fraction of eligible patients utilizes it. Objectives Assess the economic impact of bariatric surgery costs within 2 years of the index date and identify factors associated with cost differences. Setting U.S. national employer-based retrospective claims database. Methods Adults with obesity (body mass index [BMI] ≥ 35 kilograms per square meter) were identified in the Merative claims database. Individuals who had a bariatric procedure between January 2017 and December 2019, inclusive, were matched 1:1 with nonsurgical patients, based on age, BMI, sex, comorbidities, and health care costs in the year before the index date. Total and clinical care-specific costs were compared in the 2 years after the index date (excluding the cost of surgery). Results The study included 9432 surgical patients and 9432 well-matched controls. In the 2 years after the index date, follow-up was complete, and total health care costs were $5677 lower among surgical patients (P < .01). In 29 of 35 characteristics examined, health care costs were significantly reduced after surgery. The largest savings were noted among patients with type 2 diabetes ($15,270), steatohepatitis ($11,648), or ages 50-65 years ($11,105). Conclusions Bariatric surgery is associated with an average 22.6% reduction in health care costs within 2 years postindex date. Differences in health care costs varied substantially by baseline demographics, health conditions, and health care usage, highlighting surgery's economic and clinical benefits.