A Return on Investment Evaluation of the Bariatric Surgery

OBJECTIVES: Bariatric surgery is an invasive method of precipitating rapid weight loss by partially or completely removing an obese patient’s stomach. This study aims to evaluate the plan costs of bariatric surgeries using data from the Arkansas Employee Benefits Division (EBD) Claims Database to offer insights for developing coverage criteria.

METHODS: Claims records from January 2018 through December 2021 were used to identify eligible enrollees who underwent bariatric surgery in 2019. Individuals with continuous enrollment for both medical and pharmacy EBD benefits for at least one-year pre-surgery and two years post-surgery were included. Individuals with surgeries unrelated to morbid obesity were excluded. Return on Investment (ROI) served as the outcome variable, calculated as the Net ROI (difference between pre-and post-surgery plan paid amounts) divided by the Cost of Investment (total plan payment for surgery), multiplied by 100%. ROIs were compared across age groups, surgery types, and pre-surgery obesity-associated comorbidity.

RESULTS: Among 41 eligible patients, 24.39% were aged 20-39, 56.10% were aged 40-59, and 19.51% were aged 60-79. The oldest age group exhibited the highest ROI (M=0.61, SD=0.97) due to high pre-surgery pharmacy spending and Medicare’s significant contribution to the cost of surgery. No significant difference in ROI was observed between VSG (M=0.15, SD=0.84) and RYGB (M=-0.04, SD=1.30) surgery types. Before surgery, 41.4% of participants had diabetes, a rate that decreased to 31.7% post-procedure. Diabetes before surgery had a significant impact on one-year ROI (p=0.038). Insulin-dependent diabetics experienced the highest ROIs post-bariatric surgery (M=1.86 after 1 year (average savings of $19,881) and M=4.05 after 2 years from surgery (average savings of $43,561)). No other comorbidity had a statistically significant impact of this magnitude.

CONCLUSIONS: Bariatric surgery's financial benefits for insulin-dependent diabetics underscore its viability as a coverage option. The study recommends not differentiating between surgery types in terms of coverage.