BARIATRIC SURGERY IMPACT ON HEALTHCARE UTILIZATION IN A BRAZILIAN PRIVATE HEALTHCARE PROVIDERSilvana M B Kelles, Luíza O Rodrigues, Augusto C S Santos Júnior, Daniela C Azevedo, Lélia M A Carvalho, Maria da Glória C Horta, Mariana R Fernandes, Sandra O S

Avelar, Carla J Machado, Sandhi M Barreto.

UNIMED BH and Universidade Federal de Minas Gerais (UFMG)

ABSTRACT

METHODS

RESULTS - TABLEIn Brazil, the prevalence of obesity is steadily increasing at a rate of 0.89% per year. It is currently well known that obese and extremely obese individuals are more likely to have associated comorbidities, lower quality of life and shorter life expectancy compared to normal-weight individuals.Also, morbidly obese individuals increase their health care utilization and cost in about 81% when compared to a non-obese population, and in 47% when compared to a non-morbidly obese population. Clinical benefits of bariatric surgery seem established, such as sustainable weight loss and reduction in the prevalence of obesity-related comorbidities. On the other hand, its mid-term impact on healthcare utilization and costs remains controversial. Thus, the objectives of this study was to analyze healthcare use and expenditures, before and after bariatric surgery, in a cohort of Brazilian patients assisted by an HMO (UNIMED BH).

RESULTS

This study consisted of a health insurance database analysis, from which before-and-after utilization profile, per-operative problems, long-term surgical complications, and cost-utility issues were obtained for all patients who underwent bariatric surgery (from January 2004 to December 2010). Patients fulfilled the following bariatric surgery eligibility criteria, established by The National Institutes of Health: BMI≥40 kg/m² or BMI ≥35 kg/m² and comorbid conditions, such as hypertension, diabetes, sleep apnea, or severe arthropathy. Individuals under 18 years of age were excluded. Data concerning healthcare costs and utilization were retrospectively analyzed, excluding the six months immediately before or after surgery.

RESULTSDuring the study period, 4,006 patients underwent bariatric surgery. Patients’ baseline characteristics were: mean age of 36.2 (SD 10.3) years, mean BMI of 42.8 (SD 4.8) kg/m², and 80% were women. There was a consistent increase in hospital admissions after surgery (total admissions were 740 vs. 1,231; p<0.001), even when hospitalizations for plastic surgery or pregnancy-related were excluded, with a global rate of 11.89 vs. 30.18 hospitalizations per 1,000 patients/year (p<0.001).

Visits to the emergency room (ER) were less frequent in the first year, but more frequent in the third year of follow up. The overall rates of ER visits were 189.61 visits per 1,000 patients/year before surgery and 170.18 after (p=0.022). The overall healthcare expenses before and after the surgery were US$ 350 and US$ 520 per person per year, respectively (p<0.001).

Figure 1: Rate of hospital admissions in the 4 years before and after bariatric surgery (excluding the six months immediately before and after surgery and the admissions related to plastic surgery or pregnancy). The differences between the respective years before and after surgery were all statistically significant (P<0.05).

Hospital admissions per 1,000 patients/year

BARIATRIC SURGERY IMPACT ON HEALTHCARE UTILIZATION IN A BRAZILIAN PRIVATE HEALTHCARE PROVIDER

Silvana M B Kelles, Luíza O Rodrigues, Augusto C S Santos Júnior, Daniela C Azevedo, Lélia M A Carvalho, Maria da Glória C Horta, Mariana R Fernandes, Sandra O S Avelar, Carla J Machado, Sandhi M Barreto.

UNIMED BH and Universidade Federal de Minas Gerais (UFMG)

RESULTSRESULTS CONCLUSIONS

Figure 2: Average health care expenditures per patient, per semester, during the four years before (B) and after (A) bariatric surgery.

1. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA 2003;289:187-93.

2. Malta DC, Andrade SC, Claro RM, Bernal RTI, Monteiro CA. Trends in prevalence of overweight and obesity in adults in 26 Brazilian state capitals and the Federal District from 2006 to 2012. Rev Bras Epidemiol. 2014;17 Suppl 1:267-276..

3. Boido A, Ceriani V, Cetta F, Lombardi F, Pontiroli AE. Bariatric surgery and prevention of cardiovascular events and mortality in morbid obesity: mechanisms of action and choice of surgery. Nutr Metab Cardiovasc Dis. 2015.

4. KELLES SMB, MACHADO CJ, BARRETO SM. Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization. ABCD Arq Bras Cir Dig (São Paulo). 2014;27(4):261-267.

REFERENCES

Costs and hospital admissions increased consistently after bariatric surgery, even when elective or pregnancy-related interventions were excluded. Healthcare providers and policy makers must be aware that a decrease in obesity-related diseases following bariatric surgery does not necessarily result in lower mid-term healthcare utilization or costs. Time trends illustrated in this study suggest that healthcare costs might decrease to pre-surgery levels in the long term.Healthcare providers must also consider a broader evaluation of healthcare utilization and costs associated with bariatric surgery, including the impacts on quality of life, mortality and morbidity associated with the surgery, and daily use of medication, in order to provide a more comprehensive evaluation of changes before and after surgery.