Bariatric Surgery Outcome/Cost in Medicare Beneficiaries

Summary

Principal Investigator: DAVID R contact FLUM
Abstract: DESCRIPTION (provided by the applicant): Obesity is one of the leading causes of morbidity and mortality in the United States. Unfortunately, the traditional approach to obesity does not achieve satisfactory, sustained weight loss. Alternatively, the most commonly performed bariatric operations result in significantly reduced body weight sustained for at least 15 years and remarkable mprovements in comorbid conditions. The recent growth in the performance of bariatric procedures has been unprecedented, largely influenced by the development of minimally invasive techniques and increased patient and provider awareness of the potential benefits of the procedure. However, the acceptance of the procedure has been limited because of questions regarding its effectiveness in the population at large, public reporting of postoperative deaths and complications at leading medical centers and because of cost control considerations. Assessing the effectiveness and cost-effectiveness of bariatric procedures is problematic because there have been no adequate evaluations of outcome in the general population. Furthermore, the role of these procedures in higher risk patients (i.e older or more debilitated) is even less established. To address the question of bariatric procedure safety, effectiveness and cost-effectiveness we propose the following study utilizing Centers for Medicare/Medicaid Services (CMS) nationwide, Part B claims database. Over 20% of all hospitalized patients are CMS beneficiaries and while only 10% are under the age of 65, this younger, medically disabled group includes many patients who undergo bariatric surgery. The specific aims of this research are to: 1. Determine the population-level risk of adverse outcomes following bariatric surgical procedures. 2. Evaluate patient and provider factors associated with adverse outcome to help individualize risk assessments for patients being considered for bariatric procedures. 3. Perform a modeled cost effectiveness analysis of bariatric procedures compared to non-surgical approaches.
Funding Period: 2005-02-15 - 2008-01-31
more information: NIH RePORT

Top Publications

  1. ncbi Patients' experience and outcomes after laparoscopic adjustable gastric banding in Washington state
    Vincent W Lin
    Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington
    Surg Obes Relat Dis 9:701-5. 2013
  2. pmc The impact of accreditation on safety and cost of bariatric surgery
    Steve Kwon
    Surgical Outcomes Research Center in the Department of Surgery and the Department of Health Services, University of Washington, Seattle, Washington
    Surg Obes Relat Dis 9:617-22. 2013
  3. ncbi Association between health-related quality of life and body mass after adjustable gastric banding: a nonlinear approach
    Vincent W Lin
    Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA 98195, USA
    Value Health 16:823-9. 2013
  4. pmc The use, safety and cost of bariatric surgery before and after Medicare's national coverage decision
    David R Flum
    University of Washington Schools of Medicine, Pharmacy and Public Health, Seattle, WA, USA
    Ann Surg 254:860-5. 2011
  5. ncbi Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures
    David R Flum
    Department of Surgery, University of Washington, Seattle, Wash 98195 7183, USA
    JAMA 294:1903-8. 2005
  6. pmc Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions
    Leon Salem
    Department of Surgery, University of Washington School of Medicine, Seattle, Washington 98195 6410, USA
    Surg Obes Relat Dis 4:26-32. 2008

Scientific Experts

  • DAVID R contact FLUM
  • Vincent W Lin
  • Sean D Sullivan
  • Rafael Alfonso-Cristancho
  • Steve Kwon
  • Louis P Garrison
  • Andrew Wright
  • Leon Salem
  • Edwin S Wong
  • Bruce Wang
  • Edwin Wong
  • Allison Devlin

Detail Information

Publications6

  1. ncbi Patients' experience and outcomes after laparoscopic adjustable gastric banding in Washington state
    Vincent W Lin
    Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, Washington
    Surg Obes Relat Dis 9:701-5. 2013
    ..Our objective was to estimate the amount of postoperative weight loss, change in co-morbidity status, and complications after LAGB. The setting was LAGB surgical centers in Washington state...
  2. pmc The impact of accreditation on safety and cost of bariatric surgery
    Steve Kwon
    Surgical Outcomes Research Center in the Department of Surgery and the Department of Health Services, University of Washington, Seattle, Washington
    Surg Obes Relat Dis 9:617-22. 2013
    ..We used inpatient care data of those with employer-sponsored insurance plans across United States using the MarketScan Commercial Claims and Encounter Database (2003-2009)...
  3. ncbi Association between health-related quality of life and body mass after adjustable gastric banding: a nonlinear approach
    Vincent W Lin
    Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA 98195, USA
    Value Health 16:823-9. 2013
    ..To estimate the relationship between health utilities and body mass index (BMI) among a cohort of obese patients who underwent laparoscopic adjustable gastric banding (LAGB)...
  4. pmc The use, safety and cost of bariatric surgery before and after Medicare's national coverage decision
    David R Flum
    University of Washington Schools of Medicine, Pharmacy and Public Health, Seattle, WA, USA
    Ann Surg 254:860-5. 2011
    ..To determine the impact of the Centers for Medicare and Medicaid Services' (CMS) bariatric surgery national coverage decision (NCD) on the use, safety, and cost of care CMS beneficiaries...
  5. ncbi Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures
    David R Flum
    Department of Surgery, University of Washington, Seattle, Wash 98195 7183, USA
    JAMA 294:1903-8. 2005
    ..Case series demonstrate that bariatric surgery can be performed with a low rate of perioperative mortality (0.5%), but the rate among high-risk patients and the community at large is unknown...
  6. pmc Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions
    Leon Salem
    Department of Surgery, University of Washington School of Medicine, Seattle, Washington 98195 6410, USA
    Surg Obes Relat Dis 4:26-32. 2008
    ..We designed a model to evaluate the incremental cost-effectiveness of these procedures compared with nonoperative weight loss interventions and with each other...