8585ترکیب هزینه های غیر مستقیم با تحلیل هزینه - منفعت از پیوند معده تنظیم لاپاروسکوپی

Objectives The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct and indirect costs and cost savings into account. Methods Estimates of direct cost savings from LAGB were available from the literature. Although longitudinal data on indirect cost savings were not available, these estimates were generated by quantifying the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and combining these elasticity estimates with estimates of the direct cost savings to generate total savings. These savings were then combined with the direct and indirect costs of the procedure to quantify net savings. Results By including indirect costs, the time to breakeven was reduced by half a year, from 16 to 14 quarters. After 5 years, net savings in medical expenditures from a gastric banding procedure were estimated to be $4970 (±$3090). Including absenteeism increased savings to $6180 (±$3550). Savings were further increased to $10,960 (±$5864) when both absenteeism and presenteeism estimates were included. Conclusions This study presented a novel approach for including absenteeism and presenteeism estimates in cost-benefit analyses. Application of the approach to gastric banding among surgery-eligible obese employees revealed that the inclusion of indirect costs and cost savings improves the business case for the procedure. This approach can easily be extended to other populations and treatments.

Recent evidence reveals that the direct (medical) and indirect (productivity loss) burden of severe obesity, defined as having a body mass index (BMI) greater than 40 kg/m2, is substantial [1]. Bahr et al. [2] showed that annual obesity-attributable medical expenditures for the severely obese could be as high as $1270 for males and $2530 for females. Furthermore, they showed that the indirect costs resulting from severe obesity, which include increased absenteeism and health-related reductions in productivity while at work (termed presenteeism), comprised an even larger share of total obesity-attributable costs. They estimated annual indirect obesity-attributable costs of $6090 for severely obese male employees and $6690 for severely obese female employees. Because of the high costs resulting from severe obesity, effective obesity interventions have the potential to generate significant savings. To date, the most effective intervention for severe obesity is bariatric surgery; the two most common types of bariatric surgery are gastric bypass surgery and gastric banding. Both procedures have been shown to be cost-effective when focusing on direct medical expenditures [3], [4], [5], [6], [7] and [8]. Estimating changes in direct medical expenditures after a medical/surgical intervention is easily accomplished because of readily available longitudinal medical claims data. Similar data do not exist for estimating indirect costs. As a result, nearly all cost-effectiveness and cost-benefit studies focus solely on direct costs. Given that a bariatric procedure not only generates short-term work loss but also has the potential to reduce subsequent absenteeism and presenteeism, the largest components of obesity-related costs, and because employers are ultimately responsible for making coverage decisions for their employees, a lack of information on potential indirect cost implications resulting from bariatric procedures is a significant limitation. The objective of this study was to estimate the time to breakeven and 5-year net costs of laparoscopic adjustable gastric banding (LAGB) taking both direct medical and indirect absenteeism and presenteeism costs and cost savings into account. Although longitudinal data on indirect cost savings are not available, indirect cost savings were generated by estimating the relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism and combining these estimates with estimates of the direct cost savings. Although the analysis focuses on LAGB as a treatment for severe obesity, this approach can easily be applied to gastric bypass or extended to other populations and treatments.

This study presented a novel approach for estimating indirect costs savings when savings in direct costs are available. Application of the approach to gastric banding among surgery-eligible obese employees revealed that inclusion of indirect costs improves the business case for the procedure. Future studies should attempt to validate this approach by comparing the results to those generated from longitudinal data postintervention, and, if successful, apply it to other populations and treatments where data on indirect cost savings are not readily available.