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: 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
Circulation 12/2012; DOI:10.1161/CIR.0b013e31828124ad · 14.95 Impact Factor