Friday, June 10, 2011

Healthcare Cost—Benefits Versus Risks

Treating ESRD is costly. As of the end of 2007, the cost of treating
patients with ESRD amounted to $35.32 billion annually from both public and
private spending. In 2006, the average annual cost for a Medicare ESRD
patient on dialysis was $43,335.[2]

Consider the potential annual healthcare cost savings if fewer patients
required dialysis.

Additionally, kidney transplantation for those approaching dialysis or
already on dialysis would certainly improve quality of life. Transplant
numbers are also increasing each year. From 2005 to 2007, there were 53,012
kidney transplants performed in the United States.3 This represents a
20-percent increase from 2000 and a 45-percent increase from 1995.

Transplant recipients without obesity tend to have better outcomes, such as
improved patient and graft survival, compared to patients with obesity. So,
potential recipients need to lose weight to meet the standard of body mass
index (BMI) of 35kg/m2 or less. Is weight loss surgery a safe and
cost-effective way to reach the desired BMI?[4,5]

Weight loss surgery costs are actually decreasing due to efficiencies and
improved outcomes. One study, which examined hospital payments for bariatric
surgery procedures, found that payments fell from $29,563 to $27,905 from
2002 to 2006. In addition, complication rates have dropped during this same
time, despite the fact that patients having the procedures were older and

For patients with CKD, weight loss has been shown to improve renal
parameters.[7] In a study done by the University of Cincinnati College of
Medicine,[8] nine out of 45 patients with established renal disease, had
resolution, improvement, or stabilization of kidney function after gastric
bypass. Two patients already on dialysis at the time of surgery were able to
discontinue dialysis for 27 and seven months, respectively. The remaining
patients had stable renal function for 2 to 5 years postoperatively. Weight
loss surgery, thus, can decrease overall healthcare costs by delaying the
progression of disease or delaying the need for dialysis or kidney
transplantation.[8] More long-term studies are needed to analyze effects of
bariatric surgery on CKD and progression to ESRD.[9]

Weight loss surgery in patients with renal disease does carry some
risks.[10] One must consider the potential for malabsorption of not only
nutrients, but also antirejection medications.[11] For patients who are
undergoing dialysis, there are no studies that have looked at the optimal
vitamin/mineral supplementation plan for patients with ESRD following
bariatric surgery.

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