Laparoscopic Bariatric (Weight Loss) Surgery Saves Money (?)

Laparoscopic bariatric surgery returns its initial economic investment in a bit over 2 years, a study in this month's American Journal of Managed Care  asserts.  This is much more than can be said for most medical interventions  - which are cost-effective (usually meaning a cost of less than, let's say, $50,000 per quality adjusted life year), but not cost-saving (meaning that after the investment is made, medical costs actually go down.)  If this study (3651 patients in a 5 million patient database) is replicated -- this will make it more compelling for health plans to pay for this service.  Of course, few effective medical procedures are required to prove that they actually save money - most actually just make patients' lives better - which bariatric surgery has already been well-shown to do.  Also - most procedures which are initially claimed to save resources end up actually costing the system more money!

How could this be true - even if the AJMC study is absolutely correct?   During the study period (1999-2005), laparoscopic bariatric surgery was restricted to the highest risk patients, and done in a relatively small number of facilities by highly skilled high-volume surgeons.  If the procedure is used more widely, it's likely to be employed in patients with less of a "pay off."  It's also likely to be done by more surgeons with less expertise, at centers that don't have the same emphasis on multi-disciplinary programs.  

Further, in an accompanying editorial another healthcare economist points out that the savings in this study actually represent increase of cost of controls - those who had bariatric surgery didn't have lower post-operative costs!  

That's not to say that health plans shouldn't provide coverage for this procedure.  In fact, as the editorialist comments, few covered medical procedures pay for themselves.