Stanford School of Medicine, Stanford, CA.
Hamilton Medical Center, Dalton, GA.
J Am Coll Surg. 2019 Feb;228(2):171-179. doi: 10.1016/j.jamcollsurg.2018.10.021. Epub 2018 Nov 17.
Bariatric surgical procedures are an effective and enduring treatment for severe obesity. In addition to improvements in health status, bariatric operations have been noted to potentially decrease postoperative healthcare costs, particularly medication use.
We performed a longitudinal analysis of 2007-2012 claims data comparing a bariatric surgical cohort with a propensity-matched nonsurgical control group during a 5-year time period. Truven Health Analytics MarketScan Commercial Claims and Encounters Database, with a total enrollment of 56 million covered lives from all insurers and representing all 50 states, was used. An initial sample of 384,343 obese patients was identified, with a total of 5,978 matched 1:1 pairs of obese bariatric surgical patients and nonsurgical control patients designated after matching and propensity score matching procedure. Two thousand seven hundred of those matched pairs had at least 4 years of follow-up after index date.
The matched cohorts included 2,700 patients (77.2% female, mean age 47.1 years). During the 4-year follow-up period, bariatric surgical patients had 22.6% lower pharmacy costs compared with nonsurgical control patients (p < 0.001). Mean total pharmacy costs showed a sustained decrease in the surgical group compared with the matched control group ($8,411 vs $9,900; p < 0.001). Medication use in the surgical group declined significantly from 1 year preoperative to 4 years postoperative in contrast to the control group. In the 4-year postoperative period, the numbers of antidiabetic, antihypertensive, and cardiac prescriptions in the surgical patients were reduced by 73.7%, 48.3%, and 48.9%, respectively, compared with the control patients.
Total pharmacy use and costs showed a significant and sustained reduction during a 4-year follow-up period among patients undergoing gastric bypass or band operations in comparison with a propensity-matched control group.
减重手术是治疗重度肥胖的有效且持久的方法。除了改善健康状况外，减重手术还可能降低术后医疗保健成本，尤其是药物使用成本。
我们对 2007 年至 2012 年的索赔数据进行了纵向分析，比较了在 5 年时间内接受减重手术的队列与倾向匹配的非手术对照组。我们使用了 Truven Health Analytics MarketScan 商业索赔和就诊数据库，该数据库涵盖了来自所有保险公司的 5600 万参保人，代表了所有 50 个州。最初确定了 384343 名肥胖患者的样本，在进行匹配和倾向评分匹配程序后，共有 5978 对肥胖的减重手术患者和非手术对照组患者被匹配。其中有 2700 对匹配患者在指数日期后至少有 4 年的随访。
匹配队列包括 2700 名患者（77.2%为女性，平均年龄为 47.1 岁）。在 4 年的随访期间，与非手术对照组相比，减重手术患者的药房费用降低了 22.6%（p<0.001）。与匹配对照组相比，手术组的总药房费用呈持续下降趋势（$8411 比 $9900；p<0.001）。与对照组相比，手术组的药物使用从术前 1 年显著下降到术后 4 年。在术后 4 年期间，与对照组相比，手术患者的降糖药、降压药和心脏病处方数量分别减少了 73.7%、48.3%和 48.9%。
与倾向匹配的对照组相比，接受胃旁路或带手术的患者在 4 年的随访期间，总药房使用和成本显著且持续降低。
