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Identifying Bariatric Surgery Patients With the Most Favorable Cost Outcomes.

Jie Gao1, Valerie A Smith1,2,3, Matthew L Maciejewski1,2,4,5

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Area of Science:

  • Health Economics
  • Medical Informatics
  • Surgical Outcomes

Background:

  • Bariatric surgery's economic benefits can vary significantly among patient groups.
  • Identifying subgroups with optimal return on investment is crucial for resource allocation.
  • Previous analyses often mask these subgroup-specific economic effects.

Purpose of the Study:

  • To investigate if economic benefits of bariatric surgery differ across patient subgroups.
  • To identify patient groups with the most favorable cost profiles for improved return on investment.
  • To explore heterogeneous treatment effects using advanced causal inference methods.

Main Methods:

  • Retrospective cohort study of 16,538 bariatric and 16,538 matched non-surgical patients.
  • Utilized the mTree (matching + decision tree) causal machine learning method.
  • Analyzed total healthcare expenditures 3 years post-surgery using electronic health records.

Main Results:

  • Significant heterogeneity in bariatric surgery's effect on total expenditures was found across eight patient subgroups.
  • Five subgroups were replicated in a test sample, indicating robust findings.
  • Patients using insulin with a Gagne score ≤4 showed substantial post-surgical expenditure reductions (-$4311).

Conclusions:

  • Subgroup identification is essential for understanding bariatric surgery's return on investment.
  • Certain patient subgroups demonstrate more favorable post-surgical cost profiles.
  • Findings may inform prioritization of bariatric surgery for specific patient populations pending validation.