COMPARISON OF THE COSTS ASSOCIATED WITH MEDICAL AND SURGICAL-TREATMENT OF OBESITY

Background. We compared the long-term costs and outcomes of gastric by pass versus medical therapy (very dow-calorie diet plus weekly behavio ral modification) for obese patients. Methods. A successful outcome wa s defined as the loss of at least one third of excess weight that was maintained for the duration of the study. A minimal cost was assigned: $3000 for medical and $24,000 for surgical treatment. A cost per poun d of weight lost for all patients successfully monitored was calculate d. The Federal Trade Commission recently asked all weight loss program s to report this cost for patients at least 2 years after therapy. Res ults. A total of 201 patients entered surgical and 161 entered medical therapy. The surgical group was initially heavier (mean body mass ind ex [kg/m(2)] +/- SE = 49.3 +/- 0.6 versus 41.2 +/- 0.7, p < 0.01), but each group's lowest mean body mass index was similar (31.8 versus 32. 1, respectively). A significantly higher percentage of patients in the surgical versus the medical group were still successful at year 5: 89 % versus 21%. The cost per pound lost for medical therapy exceeded the cost of surgical therapy in the sixth posttreatment year (both more t han $250/pound). Conclusions. Surgical treatment appears to be more co st-effective at producing and maintaining weight loss. It is imperativ e that long-term follow-up studies be funded to definitely establish t his finding.