Financial implications of coverage for laparoscopic adjustable gastric banding

Background: Employers and insurers have become increasingly concerned about the cost implications of providing coverage for bariatric procedures. We sought to quantify the costs and potential cost savings resulting from coverage for laparoscopic adjustable gastric banding (LAGB) using a claims analysis. Methods: U.S. healthcare claims data of >7000 LAGB patients and a propensity score-matched control group were used to quantify the costs and potential cost savings resulting from LAGB for the overall surgery-eligible population and for the subset of the surgery-eligible population with diabetes mellitus. The matched control group consisted of those with a morbid obesity diagnosis code and/or a body mass index >35 kg/m(2) as reported in the Health Risk Assessment data. Results: Including the related medical payments in the 90 days before and after the procedure, the mean cost of LAGB was approximately $20,000. After placement, a modest reduction occurred in the health expenditures relative to the preoperative payments. In the postoperative period, these decreases were maintained for the LAGB sample. In contrast, the payments for the comparison sample continued to increase. As a result, the net cost of coverage for LAGB was reduced to 0 by approximately 4 years after band placement. For those with diabetes, the net costs resulting from LAGB were reduced to 0 in just >2 years. Conclusion: These results suggest that the LAGB procedure pays for itself within a relatively short period, especially for those with diabetes. (Surg Obes Relat Dis 2011;7:295-303.) (C) 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved.