Researchers: Ilan Yehoshua ^1,2, Matan Bar-Yishai¹, Limor Adler^1,3, Galit Kavan¹, Avital Bilitzky-Kopit^1,2, Limor Tal Pony¹

Background: Obesity and accompanying comorbidities such as diabetes and cardiovascular disease are increasingly common worldwide and are related to increased morbidity and mortality. Bariatric surgeries are considered the most
effective way to lose a large amount of weight.

Objectives: This study aimed to evaluate the healthcare costs of patients with obesity before and after bariatric surgery.

Method: This is a retrospective cohort study that included all patients with obesity who underwent bariatric surgery through Maccabi Healthcare Services (MHS) at any medical center in Israel between 2015 and 2019. We followed all healthcare costs for the relevant patients during the three years before and the three years after the operation.

Findings: During 2015-2019, 10,549 bariatric surgeries were performed in MHS. Overall, 10,500 bariatric surgeries were included in our analysis (49 gastric banding operations were excluded). Overall, the mean patient age was
42.6 (SD=12.5), the mean BMI was 41.3 (SD=5.0), and 67.7% of patients were females. Average annual total healthcare costs increased in all age groups; in young adults (18-39) from 3,575 NIS before to 5,732 NIS after (160% increase), in adults (40-64), from 6,960 NIS before to 8,366 NIS after (120% increase) and in the elderly (65+) from 13,747 NIS before vs. 17,386 NIS after (126% increase). Physician visits and hospitalizations accounted for most of the healthcare expenditure. Hospital costs increased in all age groups, an increase
of 187%, 130%, and 154% in young adults, adults, and the elderly.
respectively. For physician visits, healthcare costs also increased in all age
groups, with an increase of 139%, 115%, and 113% in young adults, adults,
and the elderly, respectively.

Conclusions: When assessing a medical intervention, benefits, and costs should be evaluated to ensure good decision-making about the intervention. While bariatric surgery is considered the most effective way to lose weight and improve related comorbidities, the costs after such intervention actually increase.

Recommendations: When advising patients about bariatric surgeries, healthcare costs should be considered. Choosing the right patient for the procedure is essential. Other costs, like indirect and intangible costs of obesity, which were not evaluated in this study, are significant and can't be overlooked.

Research end date: 12/2023