Bariatric surgery: a health economic perspective of the prescription costs

Abstract

Introduction: Obesity is a significant burden for the health care systems. Bariatric surgery leads to considerable weight loss and health improvement. Nevertheless, this surgery is costly and doubts about its affordability have been raised. Few studies have assessed outcomes such as drug use and costs after bariatric surgery. The aim of this study is to evaluate drug consumption and costs before and after bariatric surgery. Methods: Retrospective data from the electronic database of 72 patients, who underwent bariatric surgery in 2014 were studied. Prescription medications and comorbidities related to obesity were reviewed preoperatively and at 6 months postoperatively. Drug prices were calculated accordingly to table prices of Infarmed ® . Results: The pre and postoperatively prevalence of comorbidities related to obesity was respectively: hypertension 38.9% vs 20.8% (p < 0.001 McNemar test); type 2 diabetes 19.4% vs 9.7% (p = 0.016 McNemar test); dyslipidemia 58.3% vs 33.3% (p = 0.001 McNemar test); and sleep apnea 11.1% vs 4.17% (p = 0.125 McNemar test). A sub-analysis of patients treated for these comorbidities (n = 33) has shown that preoperatively costs related to drug and continuous positive airway pressure (CPAP) use were on average 1.26€ whereas postoperatively these costs were on average 0.53€ per patient per day (p = 0.015 Paired sample t-test). Preoperatively the number of pills and insulin per patient per day had a median of 2 and 60, while postoperatively these numbers decreased to 1 and 43, respectively (p = 0.002; p = 0.043 Wilcoxon test). These patients exhibited an improvement in their comorbidities which, remaining stable, could achieve a saving of 266.45ϵ per year. Conclusion: Bariatric surgery can decrease medication requirements, resulting in significant cost savings to the National Health Service. This surgery is pricey, but the decrease of expenditures in medications may allow a reimbursement of the investment, and this is more evident in patients with more associated comorbidities.