Impact of bariatric surgery on the medical management and costs of obese patients in France: an analysis of a national representative claims database.

BACKGROUND

Bariatric surgery (BS) procedures are increasing but few studies have investigated their influence on medical management and costs in France.

METHODS

The "Echantillon Généraliste des Beneficiaires" (EGB) is a 1/97 representative sample (n = 520,000 in 2011) of a national claims database covering about 80 % of the population. Adult patients treated for the first time with BS from January 2007 to December 2009 were identified, and a cohort including 350 patients was constituted with a 2-year follow-up before and after this primary procedure date (T). All items of reimbursed medical consumption and comorbidities over this period were identified. A comparison on the consumed resources and costs of BS was performed over time using multivariate models.

RESULTS

The annual per capita reimbursed health expenses evolved from 2633  (±3124) in year (T - 2) to 3557  (±3380) in (T - 1), to 4240  (±3840) in (T + 1) (excluding procedure cost), and to 3755  (±5037) in (T + 2) with differences according to the type of surgery. In 39 % of patients, the evolution of those costs between (T - 2) and (T + 2) decreased by 5 %. In multivariate models, the significant factors were the presence of diabetes or hypertension medications before the procedure. Most items of medical consumption increased over the period pre- and post-procedure and started to decrease in (T + 2).

CONCLUSIONS

Although this series contains mostly gastric bandings, which were less likely to affect comorbidities, the workup for preparing BS was probably an opportunity to benefit from a general clinical assessment which has generated extra short-term medical consumption and expenses began decreasing without allowing return on investment.