Patients taking significantly fewer medications after weight-loss surgery

Findings from the new study, "Bariatric Surgery Reduces National Medication Utilization in the Long-Term," were presented as part of the "Top 10 Paper Session" here at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) during ObesityWeek 2014, the largest international event focused on the basic science, clinical application and prevention and treatment of obesity. The event is hosted by the ASMBS and The Obesity Society (TOS).

"As patients lose weight after surgery, they typically see significant improvements in many obesity-related conditions including diabetes, hypertension and heart disease, while similar patients who don't have surgery often see their conditions become worse," said study author John M. Morton, MD, Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine. "This study shows these trends have significant cost implications for patients and the healthcare system at large."

Using Truven Health Analytics MarketScan® Commercial Claims and Encounters Database incorporating multiple insurers with a total enrollment of 56 million covered lives and representing all 50 states, researchers propensity-score matched the health claims of 2,700 laparoscopic gastric bypass and gastric band patients before and after surgery, and compared them to an equal number of non-surgical patients matched for body mass index (BMI) and health status.

In the year before surgery, patients spent $3,098 on medications, compared to the non-surgical group, who spent $2,303. Within 12 months though, it was those people that did not have surgery that were spending more on medicine -- $2,407 vs. $2,209 -- a trend that continued for the entire length of the study. Over the four-year period, patients with obesity incurred $9,900 in total pharmacy costs, while surgery patients spent $8,411 -- a 22.4 percent difference.

The differences were even more dramatic when researchers looked at the change in the number of medications after weight-loss surgery. Use of diabetes drugs plunged by 73.7 percent, and hypertensive and cardiac medications dropped by about 47 percent.

"Modern bariatric surgery can cut your diabetes medicines by nearly three-quarters, reduce your heart medication by about half and reduce your pharmacy bill by more than 20 percent. The impact of bariatric surgery on medication utilization is significant," said co-author Ninh T. Nguyen, MD, vice-chair of the UC Irvine Department of Surgery and chief of gastrointestinal surgery, who is also the ASMBS president.

According to the ASMBS, about 179,000 people had bariatric surgery last year at a cost ranging anywhere from $17,000 to $30,000, depending on surgical method and geography. A study in 2008 calculated the medical cost savings, between less frequent doctor visits and less use of costly drugs for obesity-related diseases, offset the price of gastric bypass, one of the most common methods of bariatric surgery, within two to four years.

"The health and economic case for bariatric surgery is compelling, yet we are only performing these operations on less than 1 percent of potential candidates," said Raul Rosenthal, MD, director of the Bariatric and Metabolic Institute at Cleveland Clinic Florida, who was not involved in the study. "We need to make rational choices when it comes to healthcare and the right choice for patients with obesity may be bariatric surgery."

About Obesity and Metabolic and Bariatric Surgery

According to the Centers of Disease Control and Prevention (CDC), more than 78 million adults were obese in 2011-2012. The ASMBS estimates about 24 million people have severe obesity. Individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals as well as an increased risk of developing more than 40 obesity-related diseases and conditions including type 2 diabetes, heart disease and cancer.

Metabolic/bariatric surgery has been shown to be the most effective and long lasting treatment for severe obesity and many related conditions and results in significant weight loss. The Agency for Healthcare Research and Quality (AHRQ) reported significant improvements in the safety of metabolic/bariatric surgery due in large part to improved laparoscopic techniques. The risk of death is about 0.1 percent and the overall likelihood of major complications is about 4 percent.