Presentation (CTI)

OBJECTIVES: Obesity continues to challenge payers worldwide. In Saudi Arabia’s private healthcare sector, the regulator has mandated coverage by private insurance payers for eligible obese patients of 15,000 SAR (4,000 USD) at the lowest insurance tier. This coverage extends to bariatric surgeries including laparoscopic sleeve gastrectomy (LSG) and gastric bypass procedures, but does not include endoscopic methods like endoscopic sleeve gastroplasty (ESG). We compared the cost consequences of treating patients with ESG or LSG, from the perspective of the private insurance payer for 1 year.
METHODS: A de novo cost calculator was developed for a theoretical 100 patients with the following cost components; cost of the procedure, attendances before and after the procedure, complications (including bleeds, gastric line leak and infection), new onset gastroesophageal reflux disease (GERD), and comorbidity resolution (including hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea and non-alcoholic fatty liver disease).Rates of the cost components were derived from the literature and costs reflected literature values where available, or private market rates according to experts.
RESULTS: To treat 100 patients, the estimated costs with ESG were 2.19 million SAR (585k USD) and 2.26 million SAR (602k USD) with LSG, representing an estimated cost reduction of 2.9% with ESG. The cost of the procedure was 15,000 SAR for both ESG and LSG, in line with the regulator’s policy, hence, ~67% of the total cost for both options is on the procedure itself. Beyond this, the cost of complications and follow up attendances was less with ESG vs LSG, though the cost of comorbidities was higher with ESG.
CONCLUSIONS: Based on this analysis, insurance payers are not expected to increase total spending over 1 year with the introduction of ESG for eligible patients. Further research is required to validate these findings.