Invited Critique |

Is Bariatric Surgery Worth It?  Comment on “Impact of Bariatric Surgery on Health Care Costs of Obese Persons”

Edward H. Livingston, MD
JAMA Surg. 2013;148(6):561. doi:10.1001/jamasurg.2013.1515.
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Is bariatric surgery worth it? Maybe not. Accumulating evidence suggests there is no economic benefit for weight loss surgery. Long-term follow-up from the Swedish Obese Subjects study reported in JAMA showed that although fewer medications were used by bariatric patients compared with controls, the bariatric patients used substantially more hospital resources.1 A formal cost-effectiveness study using very high-quality data from the US Department of Veterans Affairs did not show a cost benefit for Roux-en-Y gastric bypass.2 In this issue of JAMA Surgery,3 an analysis of claims paid by BlueCross BlueShield for bariatric surgery patients for as long as 6 postoperative years failed to demonstrate a cost benefit for weight loss surgery. Coupled with findings that bariatric surgery confers little to no long-term survival benefit,4 these observations show that bariatric surgery does not provide an overall societal benefit. In other words, the indications for bariatric surgery should be viewed in terms of individual patient benefit without anticipating that there will be cost savings to a health care system by offering this treatment.

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