Matthew L Maciejewski, Lindsay Zepel, Valerie A Smith, David E Arterburn, Mary K Theis, Aileen Baecker, Caroline Sloan, Amy G Clark, Ryan M Kane, Christopher R Daigle, Karen J Coleman, Aniket A Kawatkar
{"title":"糖尿病患者减肥手术后的健康支出：胃旁路和袖式胃切除术的比较。","authors":"Matthew L Maciejewski, Lindsay Zepel, Valerie A Smith, David E Arterburn, Mary K Theis, Aileen Baecker, Caroline Sloan, Amy G Clark, Ryan M Kane, Christopher R Daigle, Karen J Coleman, Aniket A Kawatkar","doi":"10.7326/ANNALS-24-00480","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes.</p><p><strong>Objective: </strong>To compare health expenditures 3 years before and 5.5 years after bariatric surgery between patients with diabetes undergoing RYGB versus SG.</p><p><strong>Design: </strong>Retrospective cohort study using target trial emulation principles.</p><p><strong>Setting: </strong>Integrated health system.</p><p><strong>Patients: </strong>Patients with diabetes undergoing RYGB (<i>n</i> = 3147) or SG (<i>n</i> = 3510) from 2012 to 2019.</p><p><strong>Measurements: </strong>Total, inpatient, outpatient, and medication expenditures.</p><p><strong>Results: </strong>Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8 kg/m<sup>2</sup>, and average age was 50 years. Expenditures per 6-month period decreased by about 30% for both groups, from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (CI, $2151.07 to $2770.30) 5.5 years after RYGB and from $3918.37 (CI, $3658.75 to $4196.40) 3 years before to $2658.15 (CI, $2279.17 to $3100.16) 5.5 years after SG. Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, -$217.02 [CI, -$671.29 to $201.96]) except for the first 6 months, when expenditures were transiently higher in the RYGB group (difference, $564.32 [CI, $232.60 to $895.20]), driven by a higher inpatient admission rate. Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.</p><p><strong>Limitation: </strong>Unobserved confounding.</p><p><strong>Conclusion: </strong>Overall expenditures decreased substantially in the postsurgical period, primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.</p><p><strong>Primary funding source: </strong>National Institute of Diabetes and Digestive and Kidney Diseases.</p>","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"305-314"},"PeriodicalIF":19.6000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.\",\"authors\":\"Matthew L Maciejewski, Lindsay Zepel, Valerie A Smith, David E Arterburn, Mary K Theis, Aileen Baecker, Caroline Sloan, Amy G Clark, Ryan M Kane, Christopher R Daigle, Karen J Coleman, Aniket A Kawatkar\",\"doi\":\"10.7326/ANNALS-24-00480\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes.</p><p><strong>Objective: </strong>To compare health expenditures 3 years before and 5.5 years after bariatric surgery between patients with diabetes undergoing RYGB versus SG.</p><p><strong>Design: </strong>Retrospective cohort study using target trial emulation principles.</p><p><strong>Setting: </strong>Integrated health system.</p><p><strong>Patients: </strong>Patients with diabetes undergoing RYGB (<i>n</i> = 3147) or SG (<i>n</i> = 3510) from 2012 to 2019.</p><p><strong>Measurements: </strong>Total, inpatient, outpatient, and medication expenditures.</p><p><strong>Results: </strong>Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8 kg/m<sup>2</sup>, and average age was 50 years. Expenditures per 6-month period decreased by about 30% for both groups, from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (CI, $2151.07 to $2770.30) 5.5 years after RYGB and from $3918.37 (CI, $3658.75 to $4196.40) 3 years before to $2658.15 (CI, $2279.17 to $3100.16) 5.5 years after SG. Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, -$217.02 [CI, -$671.29 to $201.96]) except for the first 6 months, when expenditures were transiently higher in the RYGB group (difference, $564.32 [CI, $232.60 to $895.20]), driven by a higher inpatient admission rate. Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.</p><p><strong>Limitation: </strong>Unobserved confounding.</p><p><strong>Conclusion: </strong>Overall expenditures decreased substantially in the postsurgical period, primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.</p><p><strong>Primary funding source: </strong>National Institute of Diabetes and Digestive and Kidney Diseases.</p>\",\"PeriodicalId\":7932,\"journal\":{\"name\":\"Annals of Internal Medicine\",\"volume\":\" \",\"pages\":\"305-314\"},\"PeriodicalIF\":19.6000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.7326/ANNALS-24-00480\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/ANNALS-24-00480","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/28 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.
Background: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes.
Objective: To compare health expenditures 3 years before and 5.5 years after bariatric surgery between patients with diabetes undergoing RYGB versus SG.
Design: Retrospective cohort study using target trial emulation principles.
Setting: Integrated health system.
Patients: Patients with diabetes undergoing RYGB (n = 3147) or SG (n = 3510) from 2012 to 2019.
Measurements: Total, inpatient, outpatient, and medication expenditures.
Results: Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8 kg/m2, and average age was 50 years. Expenditures per 6-month period decreased by about 30% for both groups, from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (CI, $2151.07 to $2770.30) 5.5 years after RYGB and from $3918.37 (CI, $3658.75 to $4196.40) 3 years before to $2658.15 (CI, $2279.17 to $3100.16) 5.5 years after SG. Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, -$217.02 [CI, -$671.29 to $201.96]) except for the first 6 months, when expenditures were transiently higher in the RYGB group (difference, $564.32 [CI, $232.60 to $895.20]), driven by a higher inpatient admission rate. Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.
Limitation: Unobserved confounding.
Conclusion: Overall expenditures decreased substantially in the postsurgical period, primarily due to reductions in pharmacy expenditures, with no differences between RYGB and SG except in the first 6 months after surgery.
Primary funding source: National Institute of Diabetes and Digestive and Kidney Diseases.
期刊介绍：
Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.
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