Adler Limor, Bar Yishay Mattan, Shiraz Vered, Tal Pony Limor, Kowen Sandbank Galit, Bilitzky Kopit Avital, Yehoshua Ilan
Health Division, Maccabi Healthcare Services, Tel Aviv-Yafo, Israel
Family Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
BMJ Open. 2025 Aug 4;15(8):e100223. doi: 10.1136/bmjopen-2025-100223.
Studies show conflicting evidence regarding individuals' healthcare costs following bariatric surgeries. This study aimed to evaluate the healthcare costs of individuals with obesity before and after bariatric surgery and compare them to a matched control group.
Retrospective cohort study.
Primary care nationwide.
This retrospective cohort study included all adults insured by Maccabi Healthcare Services who underwent bariatric surgery between 2015 and 2019 and a control group matched by body mass index, age, gender and socioeconomic status (case n=10 178).
We collected each patient's annual costs for six consecutive years (3 years before and after the index date). We used generalised linear mixed models to assess the interaction between time (presurgery vs postsurgery) and group (bariatric vs control) on healthcare costs during the second and third years before and after surgery, adjusting for covariates not matched between groups, including smoking status, ethnicity and comorbidities. The analyses were made in three age groups: young adults (18-39), adults (40-64) and older adults (65 or more).
From 2015-2019, 10 178 bariatric surgeries were performed (51.9% sleeve gastrectomy, 36.7% bypass surgeries and 11.4% combined surgeries). Total healthcare costs increased after the index date in both the bariatric and control groups, with a greater absolute increase in the bariatric group; however, the between-group differences in cost changes were not statistically significant (p=0.987 for younger adults, p=0.311 for adults and p=0.771 for older adults).
While healthcare costs increased in both groups following the index date, the lack of a significant difference between the bariatric and control groups suggests that bariatric surgery may not lead to short-term cost savings. Ongoing long-term follow-up is essential to fully understand its economic impact.
关于减肥手术后个体的医疗保健费用，研究显示的证据相互矛盾。本研究旨在评估肥胖个体在减肥手术前后的医疗保健费用，并将其与匹配的对照组进行比较。
回顾性队列研究。
全国初级保健机构。
这项回顾性队列研究纳入了2015年至2019年间接受减肥手术的所有由马卡比医疗服务公司承保的成年人，以及一个按体重指数、年龄、性别和社会经济地位匹配的对照组（病例数=10178）。
我们连续六年收集了每位患者的年度费用（索引日期前3年和后3年）。我们使用广义线性混合模型来评估时间（术前与术后）和组（减肥手术组与对照组）在手术前后第二和第三年对医疗保健费用的交互作用，并对组间未匹配的协变量进行调整，包括吸烟状况、种族和合并症。分析在三个年龄组中进行：年轻人（18 - 39岁）、成年人（40 - 64岁）和老年人（65岁及以上）。
2015年至2019年期间，共进行了10178例减肥手术（51.9%为袖状胃切除术，36.7%为旁路手术，11.4%为联合手术）。索引日期后，减肥手术组和对照组的总医疗保健费用均有所增加，减肥手术组的绝对增加幅度更大；然而，两组之间费用变化的差异无统计学意义（年轻人p = 0.987，成年人p = 0.311，老年人p = 0.771）。
虽然索引日期后两组的医疗保健费用均有所增加，但减肥手术组与对照组之间缺乏显著差异表明，减肥手术可能不会带来短期成本节约。持续的长期随访对于充分了解其经济影响至关重要。
