Sampalis John S, Liberman Moishe, Auger Stephane, Christou Nicolas V
Section of Bariatric Surgery, Division of General Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Obes Surg. 2004 Aug;14(7):939-47. doi: 10.1381/0960892041719662.
The treatment of obesity and related comorbidities are significant financial burdens and sources of resource expenditure. This study was conducted in order to assess the impact of weight-reduction surgery on health-related costs.
This was an observational two-cohort study. The treatment cohort included patients having undergone weight-reduction (bariatric) surgery at the McGill University Health Centre (MUHC) between 1986 and 2002. The control group included age and gender matched obese patients who had not undergone weight-reduction surgery from the Quebec provincial health insurance database (RAMQ). The cohorts were followed for a maximum of 5 years from inception. The primary outcome measure was overall direct healthcare costs. Secondary outcomes included cost analysis by diagnostic category for the treatment of new medical conditions following cohort inception.
The cohorts were well-matched for age, gender and duration of follow-up. Patients having undergone bariatric surgery had significant reductions in mean percent initial excess weight loss (67.1%, P <0.001) and in percent change in initial body mass index (34.6%, P <0.001). Bariatric surgery patients had higher total costs for hospitalizations (per 1,000 patients) in the first year following cohort inception (surgery cohort = CDN 12,461,938 dollars; control cohort = CDN 3,609,680 dollars). At 5 years after cohort inception, average cumulative costs for operated patients were CDN 19,516,667 dollars versus CDN 25,264,608 dollars, for an absolute difference of almost CDN 6,000,000 dollars per 1,000 patients.
Weight-reduction surgery in morbidly obese patients produces effective weight loss and decreases long-term direct health-care costs. The initial costs of surgery can be amortized over 3.5 years.
肥胖症及相关合并症的治疗是巨大的经济负担和资源消耗来源。本研究旨在评估减重手术对健康相关成本的影响。
这是一项观察性双队列研究。治疗队列包括1986年至2002年间在麦吉尔大学健康中心（MUHC）接受减重（减肥）手术的患者。对照组包括来自魁北克省医疗保险数据库（RAMQ）的年龄和性别匹配但未接受减重手术的肥胖患者。从队列开始起，对这些队列进行最长5年的随访。主要结局指标是总体直接医疗成本。次要结局包括对队列开始后新出现的医疗状况进行诊断分类的成本分析。
这些队列在年龄、性别和随访时间方面匹配良好。接受减肥手术的患者初始超重平均减轻百分比（67.1%，P<0.001）和初始体重指数变化百分比（34.6%，P<0.001）有显著降低。在队列开始后的第一年，减肥手术患者的住院总费用（每1000名患者）更高（手术队列 = 12461938加元；对照队列 = 3609680加元）。在队列开始5年后，手术患者的平均累积成本为19516667加元，而对照患者为25264608加元，每1000名患者的绝对差异近6000000加元。
病态肥胖患者的减重手术能有效减轻体重并降低长期直接医疗成本。手术的初始成本可在3.5年内摊销。
