Interview: A Look Into the Value of Bariatric Surgery Among Vets

Veterans Health Today spoke with Matt Maciejewski, PhD, research career scientist for the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, about his recent study and the real-world implications of its results.

Among a cohort of veterans, Dr Maciejewski and colleagues found that total health care expenditures increased immediately after bariatric surgery. However, they found that the value of bariatric surgery is strongly associated with improvements in health, not in the potential to decrease health care costs.

Dr Maciejewski, who is also a professor in the department of population health sciences at Duke University study author, Valerie Smith, DrPH, an Investigator with ADAPT and fellow assistant professor in the department of population health sciences.

The findings of this study were published online in JAMA Surgery (doi:10.1001/jamasurg.2019.3732)

What existing data led you and your coinvestigators to conduct this research?

Our team has conducted a number of studies comparing long-term outcomes of veterans with obesity who did or did not undergo bariatric surgery, but the existing evidence about the business case and return on investment for bariatric surgery is mixed.

We thought it was important to compare longterm VA expenditures because no studies on US-based cohorts examined costs out to 10 years after surgery and most prior studies examined cohorts that predominantly included women in their 40s.

There was a need to begin to develop evidence that represented the experience of veterans having bariatric surgery, who are predominantly male and in their 40s and 50s.

Please describe your study and its results. Were any of the outcomes particularly surprising?

We found that total VA health care expenditures of veterans having bariatric surgery increased immediately following surgery but converged with those of patients who had not undergone surgery by 6 years after surgery.

At 10 years after surgery, mean VA health care expenditures of patients who had received bariatric surgery had still not dropped below that of patients not receiving surgery. This finding is consistent with prior work that we had done comparing VA expenditures at 3 years between Veterans with obesity who did or did not undergo bariatric surgery.

What are the possible real-world applications of these findings in clinical practice?

The real-world implications of these findings are that the value of bariatric surgery provided in VA for Veterans lies primarily in its associations with improvements in health and not in its potential to decrease health care costs.

Do you and your co-investigators intend to expand upon this research? Or do you feel that additional research will be done in the future?

Yes, we would like to explore the expenditure trends of surgical patients in more detail to understand the specific reasons for their higher expenditures following surgery.

We have also submitted a National Institutes of Health grant to be able to examine long-term expenditures in non-Veteran cohorts to understand whether the results we observed in this Veteran cohort are also found in non-Veteran patients receiving bariatric surgery.