The Cost-Effectiveness of Non-surgical Obesity Therapies

| March 1, 2015

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania. Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida.


Dear Colleagues,
In this month’s installment of “The Medical Student Notebook,” Harvard Medical Student Benjamin Rome discusses the cost effectiveness of bariatric surgery. He provides a brief review of the literature examining the cost effectiveness of weight loss procedures, such as Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB).

It is important to note the cost effectiveness of even modest, non-surgical weight loss. Yes, Raul! Even non-surgical weight loss! Recently published articles[1–5] have measured multiple aspects of obesity that affect expenditures for both individuals and the United States health care system as a whole. These aspects include comorbidity and mortality rates pre- and post-weight loss, quality of life outcomes, and medical and pharmaceutical cost savings. As many of you know, these outcomes have been well studied in bariatric surgery cost-effectiveness research.

Current estimates for the cost of obesity range from $147 billion to nearly $210 billion per year, which is 21 percent of total national health care spending.[6] Both medical and surgical weight loss treatments have been proven to be effective at improving comorbidity and mortality, which translates to cost savings in healthcare. Therefore, even modest medical weight loss among Americans would have an impact on the US economy—improving comorbidities, such as type 2 diabetes (T2DM), hypertension, fatty liver disease, and obstructive sleep apnea. I once read a statistic that if obesity trends were lowered by reducing the average adult BMI by only five percent…the country could save $29.8 billion in five years, $158 billion in 10 years and $611.7 billion in 20 years.[7] I translated that informaiton to mean that if everyone in America lost 11 pounds, it would translate to enough cost savings to significantly reduce the entire national debt by 2030.

But how do we spread this message that modest weight loss can go a long way when it comes to the financial costs of obesity and encourage action among all stakeholders? First, we need to acknowledge that we have achieved great first steps in defining obesity by assessing ones BMI, the declaration by the American Medical Association that obesity is a disease, by clearly labeling nutrition information and ingredients on labels and menus, and the efforts made to ensure kids receive healthy lunches in schools. Another notable achievement is the availability of safe and effective pharmacologic treatment for weight loss and maintenance.

We need to continue spreading the message and educating ALL stakeholders about the benefits of weight loss (whether via behavior modification, pharmacologic treatment, or surgery) to individuals and to our government. We have made great strides to have received coverage from CMS for both behavioral treatments of obesity as well as bariatric surgery.  The next step is to achieve universal coverage for the pharmacologic treatment for patients that suffer from the disease of obesity.

The Obesity Action Coalition (OAC) is currently focusing efforts on such coverage. The Treat and Reduce Obesity Act (TROA) will “provide Medicare recipients and their healthcare providers with meaningful tools to treat and reduce obesity by improving access to obesity screening and counseling services, and new prescription drugs for chronic weight management.”

Currently, the OAC is urging Congress to cosponsor and support final passage of this important legislation through personal visits to Representatives and Senators. They also encourage you to reach out to your own Senators and Representatives. You can do so by visiting The OAC’s Legislative Action center (http://www.obesityaction.org/advocacy/legislative-action-center) and clicking the “Take Action” button.

I have been a part of the OAC visits to Capitol Hill in Washington, DC, in the past. I think that advocating for the TROA will require re-educating Congress members on obesity as a disease using evidence-based information and assuring them that these aren’t the “phen phen” days of weight-loss drugs. Today’s approved therapies are safe and effective and warrant reimbursement. Part of this new conversation will be the cost effectiveness of weight loss and government’s return on investment on covering all approved therapies for obesity treatment.

Sincerely,
Christopher Still, DO, FACN, FACP

References
1.    Finkelstein EA, Kruger E, Karnawat S. Cost-effectiveness analysis of Qsymia for weight loss. Pharmacoeconomics. 2014 Jul 2. [Epub ahead of print]
2.    Myers VH, McVay MA, Brashear MM, et al. Five-year medical and pharmacy costs after a medically supervised intensive treatment program for obesity. Am J Health Promot. 2014;28(6):364–371.
3.    Finkelstein EA1, Kruger E. Meta- and cost-effectiveness analysis of commercial weight loss strategies. Obesity (Silver Spring). 2014;22(9):1942–1951. Epub 2014 Jun 24.
4.    Rothberg AE, McEwen LN, Kraftson AT, et al. The impact of weight loss on health-related quality-of-life: implications for cost-effectiveness analyses. Qual Life Res. 2014;23(4):1371–1376. Epub 2013 Oct 16.
5.    Ahern AL, Aveyard PN, Halford JC, et al.Weight loss referrals for adults in primary care (WRAP): protocol for a multi-centre randomised controlled trial comparing the clinical and cost-effectiveness of primary care referral to a commercial weight loss provider for 12 weeks, referral for 52 weeks, and a brief self-help intervention [ISRCTN82857232]. BMC Public Health. 2014;14:620.
6.    Levi J, Segal LM, St Laurent R, Lang A, Rayburn J. F as in fat: how obesity threatens America’s future 2012. 2012. http://healthyamericans.org/report/100/. Accessed March 7, 2015
7.    Robert Johnson Foundation. F as in Fat. how obesity threatens America’s future 2013. August 2013. http://healthyamericans.org/report/108/. Accessed March 7, 2015.

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