Incorporating Indirect Costs into a Cost-Benefit Analysis of Laparoscopic Adjustable Gastric Banding
ABSTRACT The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account.
Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings.
By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included.
This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments.
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ABSTRACT: Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update.Circulation 12/2012; 127(1). DOI:10.1161/CIR.0b013e31828124ad · 14.95 Impact Factor
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ABSTRACT: The increasing prevalence of obesity has now become a global concern. Forecasts of its health and financial ramifications have prompted the need for effective interventions. Bariatric surgery is an effective measure to control obesity and its related comorbidities, but its high upfront costs have raised questions about its cost-effectiveness. In this study we evaluated the health care-related direct cost savings after bariatric surgery. Data were prospectively obtained from patients who underwent bariatric surgery between May 2008 and April 2011, and a review was performed. These patients' annual cost of regular medications, hospital admissions and outpatient clinic visits were compared with the postoperative costs of these services. Data were collected from January 2005 to April 2012. The analysis included 88 patients, 17 of whom were men and 71 were women. The procedures included 36 laparoscopic adjustable gastric banding, 33 sleeve gastrectomies and 19 Roux-en-Y gastric bypasses. All procedures were laparoscopic. Data were collected from patients during a median preoperative period of 60 months (range, 42-75 months) and a median postoperative period of 24 months (range, 12-45 moths). Annual savings were £11 452 on medications, £16 420 on hospital admissions and £2532 on outpatient clinic visits. Total annual savings were £30 404. Given the rising prevalence of morbid obesity, bariatric surgery is a cost-effective treatment for morbid obesity and should be made available to morbidly obese patients.Asian Journal of Endoscopic Surgery 07/2013; DOI:10.1111/ases.12042