Evaluación económica del tratamiento quirúrgico de la obesidad / Economic evaluation of surgical treatment of obesity

INTRODUCCIÓN: La cirugía bariátrica es el mejor tratamiento de la obesidad mórbida a largo plazo. El ahorro generado por la mejoría de las comorbilidades podría justificar el empleo de más recursos sanitarios. MÉTODOS: Estudio observacional, descriptivo, longitudinal y retrospectivo, de pacientes a los que se les realizó un bypass gástrico, en el Hospital Universitario Central de Asturias entre 2003 y 2012. El seguimiento mínimo se estableció en dos años. Calculamos de manera individualizada el coste para cada uno de los pacientes intervenidos (bottom-up), así como según el grupo relacionado por el diagnóstico (GRD) (top-down). RESULTADOS: De los 307 pacientes del estudio, el coste medio del ingreso calculado por GRD fue de 6.545,9€ y el calculado por paciente de 10.572,2€. El GRD 288 representa al 91% de la serie con un valor de 4.631€. El cálculo estimativo del ahorro que supuso en nuestro entorno sanitario la disminución del número de fármacos de 2,86 a 0,78 por paciente medicado, representó 4.433€ por paciente intervenido si padecía todas las comorbilidades analizadas. CONCLUSIONES: El bypass gástrico en el Hospital Universitario Central de Asturias a los dos años de la cirugía, en pacientes con pluripatología consiguió un ahorro solo en fármacos que podría compensar los gastos inherentes al tratamiento quirúrgico. El coste por proceso mediante GRD se mostró insuficiente a la hora de hacer una correcta evaluación económica, por lo que recomendamos un método de evaluación de coste por paciente

INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was €6,545.90, and the average cost per patient was €10,572.20. DRG 288 represented 91% of the series, with a value of €4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of €4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method

Economic evaluation of surgical treatment of obesity. / Evaluación económica del tratamiento quirúrgico de la obesidad.

INTRODUCTION: Obesity surgery is the best treatment for extreme obesity, with demonstrated long-term positive outcomes. The potential cost-savings generated by the improvement of comorbidities after surgery can justify the allocation of more resources in the surgical treatment of obesity. METHODS: This was an observational, descriptive, longitudinal and retrospective study. Eligible patients underwent Roux-en-Y gastric bypass surgery at the Hospital Universitario Central de Asturias between 2003 and 2012. The established minimum follow-up period was two years. We calculated the individualized cost per patient treated (bottom-up) as well as per Diagnosis-Related Group (DRG) codes (top-down). RESULTS: Our study included 307 patients. The average cost per hospitalization calculated by DRG codes was €6,545.90, and the average cost per patient was €10,572.20. DRG 288 represented 91% of the series, with a value of €4,631. The number of medications also decreased during this period, from 2.86 to 0.78 per medically treated patient, representing a cost reduction of €4,433 per patient with all the obesity-related comorbidities analyzed. CONCLUSIONS: Two years after Roux-en-Y gastric bypass conducted at Hospital Universitario Central de Asturias, the savings in drug costs for patients with multiple pathologies would compensate the inherent costs of the surgical treatment itself. Our results showed that DRG-related costs was insufficient to make a correct economic evaluation, so we recommend an individualized cost calculating method.