Bariatric Surgery

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Bariatric Surgery

• Treating Obesity in the Workforce
• An investment with returns

HCAI 5313 -- Schumacher
Craig Desmond -- 4/4/09
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Executive Summary

• Rates of obesity are increasing dramatically
• Obesity leads to multiple other diseases
• Obesity and disease affect working-age people
• Employer costs of obesity are rising at the same
  pace as the obesity itself
• Direct Healthcare cost
• Losses due to absenteeism and presenteeism

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Executive Summary

• Diet, Exercise, Medications not yet effective
• Surgical therapy for obesity
• Techniques, Outcomes
• Costs, Benefits
• Data on Benefit plans for Bariatric Surgery

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Obesity Trends Among U.S. AdultsBRFSS, 1996
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014 15-19
Source Behavioral Risk Factor Surveillance
System, CDC.
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Obesity Trends Among U.S. AdultsBRFSS, 2006
(BMI 30, or 30 lbs. overweight for 5 4
person)
No Data lt10 1014 15-19
2024 2529
30
Source Behavioral Risk Factor Surveillance
System, CDC.
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Why the Obesity Epidemic?

• Lifestyle choice?
• Moral failing?
• Obesity is increasingly being classified as a
  disease
• National Institutes of Health
• World Health Organization
• Interplay of genetics with current
  environmentBiology loads the gun, modern life
  pulls the trigger

Stein. In Washington Post, November 2003
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Supersize Me!!
Images from National Geographic, 2004
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Genetic Component??
The rapid increase in obesity incidence over
recent years suggests that environmental and
lifestyle influences in addition to other
physiopathological or genetic determinants are
independently affecting the energy balance
equation adjustment. Thus, it is estimated that
4070 of the variation in BMI is heritable,
while cultural and societal factors may explain
at least 30 of the variation.
Marti et al. Int J Obes Relat Metab Disord 2004.
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(No Transcript)
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Medical Impact of Obesity

• Obstructive Sleep Apnea
• Diabetes
• High Blood Pressure
• Degenerative Joint Disease knees or hips
• Gastro-esophageal reflux (GERD)

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Risk of Disease Rises with Obesity
Oster. Am J Managed Care 2000
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Medical Impact of Obesity
A 25 year old man with BMI gt 40 loses about 12
years of life expectancy.
Fontaine...Allison. JAMA 2003 289 187-193
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Employee Healthcare Costs
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Missed work related to BMI
Texas State Comptrollers Report, 2006
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Obesity has roughly the same association with
chronic health conditions as does twenty years
aging this greatly exceeds the associations of
smoking or problem drinking. Roland Sturm,
Senior Economist, RAND Corporation, 2002
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Hours Productivity Lost per Week
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Texas State Comptrollers Report, 2006
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Obesity Rates by Age Group
Texas State Comptrollers Report, 2006
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Employers are not choosing to become involved in
waging the war on obesitythey are already
involved. Employers today are paying a high price
in health care costs, lost productivity and
absenteeism due to disability and even death
connected to obesity. LuAnn Heinen, Director,
Institute on the Costs and Health Effects of
Obesity, National Business Group on Health (2005)
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Bariatric Surgery Outcomes
22,094 patients
Buchwald et al. JAMA. 2004
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Bariatric Surgery - Cost Savings

• Case control study in Canada
• 1,035 surgical patients
• 5,746 case matched obese but healthy controls
• Over a 5 year study period
• 89 lower mortality rate in surgical group
• 45 lower costs in surgical group
• Above findings do include all care for surgical
  group

Christou. Annals of Surg 240(3) 416-424.
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Bariatric Surgery - Cost Savings

• Case control study
• Tracked costs incurred by private insurance -
  U.S.
• 3,651 patients underwent surgery from 1999-2005
• Each patient matched to obese control subject
• Mean cost of surgery
• 26,000 for open surgery (outmoded)
• 17,000 for laparoscopic surgery (current)
• Break even at 2 years for laparoscopic surgery

Cremieux. Am J Manag Care. 2008
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Cost of Accepted Medical InterventionsCompare to
bariatric surgery

• CABG (Heart bypass surgery) 35-40,000
• Knee Joint replacement 15-20,000
• Hospitalization - Heart Failure 15-25,000(30-4
  0 are re-admitted within 6 mos.)
• Diabetes care 10,000/yr

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References

• Mokdad et al. JAMA 286(10) 1195-1200.
• Allison et al. JAMA 282(16) 1530-1537.
• Birmingham et al. JAMC 160(4) 484-488.
• Colditz. Am J Clin Nutr 55 503S-507S.
• Thompson, in Health Affairs 21(2) 245.
• USA Today/Workplace, 9-1-2003.
• Charuzi et al. Am J Clin Nutr 55 594S-596S.
• Pories et al. Am J Clin Nutr 55 582S-585S.
• Carson et al. Arch Int Med 154 193-200.
• CDC, Natl Center for Health Statistics, NHANES,
  2001.
• Buchwald et al. JAMA 2004 292 1724-1737.
• Christou et al. Ann Surg 2004 240 (3)
  416-424.
• Milliman Research, March 2004.
• Daviglus et al. JAMA 292(22) 2743-2749.
• Thorpe et al. Health Affairs 20 Oct 2004.
  W4-480-487.
• Stein R. Is Obesity A Disease? Online 16
  February 2005. lthttp//www.washingtonpost.com/ac2/
  wpdyn?pagenamearticlenodecontentIdA20220-200
  3Nov9notFoundtruegt.