Impact of bariatric surgery on the medical management and costs of obese patients in France: an analysis of a national representative claims database.

BACKGROUND: Bariatric surgery (BS) procedures are increasing but few studies have investigated their influence on medical management and costs in France.
METHODS: The "Echantillon Généraliste des Beneficiaires" (EGB) is a 1/97 representative sample (n = 520,000 in 2011) of a national claims database covering about 80 % of the population. Adult patients treated for the first time with BS from January 2007 to December 2009 were identified, and a cohort including 350 patients was constituted with a 2-year follow-up before and after this primary procedure date (T). All items of reimbursed medical consumption and comorbidities over this period were identified. A comparison on the consumed resources and costs of BS was performed over time using multivariate models.
RESULTS: The annual per capita reimbursed health expenses evolved from 2633 <euro> (±3124) in year (T - 2) to 3557 <euro> (±3380) in (T - 1), to 4240 <euro> (±3840) in (T + 1) (excluding procedure cost), and to 3755 <euro> (±5037) in (T + 2) with differences according to the type of surgery. In 39 % of patients, the evolution of those costs between (T - 2) and (T + 2) decreased by 5 %. In multivariate models, the significant factors were the presence of diabetes or hypertension medications before the procedure. Most items of medical consumption increased over the period pre- and post-procedure and started to decrease in (T + 2).
CONCLUSIONS: Although this series contains mostly gastric bandings, which were less likely to affect comorbidities, the workup for preparing BS was probably an opportunity to benefit from a general clinical assessment which has generated extra short-term medical consumption and expenses began decreasing without allowing return on investment.