How Obesity Surgery Can Save Billions

As an internist, who does not perform operations on people, it is indeed humbling having to acknowledge that surgery is perhaps the best treatment for severe obesity, something widely considered a “medical” condition. To add insult to injury, there is now an accumulating body of evidence that illustrates not only that bariatric surgery is one of the most effective treatments known to man in terms of reducing morbidity and mortality, but also a treatment that can literally save the health care system billions of dollars.

This slightly embarrassing (for non-surgeons) fact is once again illustrated by the latest study on this topic just published in this month’s issue of Diabetes Care by Catherine Keating and colleagues from Monash University, Melbourne, Australia.

In this paper, the researchers compared the cost-effectiveness of surgically induced weight loss to conventional therapy for the management of recently diagnosed type 2 diabetes in class I/II obese patients. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between two intervention groups: surgically treated patients vs. conventionally treated obese patients with type 2 diabetes.

Intervention costs were extrapolated based on observed resource utilization during the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs (Quality-Adjusted Life Years) were sourced from published literature. A health care system perspective was adopted for the analysis. Costs and outcomes were discounted annually at 3% and presented in 2006 Australian dollars (AUD) (current currency exchange: 1 AUD = 0.87 CND).

The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively.

The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.

Obviously, when extrapolated to the millions of patients diagnosed with type 2 diabetes, most of who have Class 1 obesity (or greater), the potential savings are in the billions.

And this analysis only accounts for the saving from treating diabetes – when you add the costs for reducing heart disease, cancers, need for joint replacements, incontinence, sleep apnea, liver disease, fertility treatments and other important obesity related comorbidities, the savings to the health care system are probably in the 10s of billions. Remember, this analysis looked at class I and II obesity – the potential savings are far greater in patients with more severe obesity.

So what is stopping us from offering more obesity surgery to the 100s of 1000s of Canadians who would benefit. Is it simply bias and discrimination against obese people? Or do we really think that somehow magically the obesity epidemic will suddenly disappear?

As I’ve written before, no health system can afford to NOT increase spending on obesity management. If we don’t, we will never have enough diabetes centres, heart hospitals, cancer wards or orthopedic clinics to deal with the multitudes of patients disabled and defeated by obesity.

As the authors of this study conclude, surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class I/II obese patients in Australia – I have no doubt that the savings would be as great in Canada.

Edmonton, Alberta