Lynne Pezzullo: We’ve estimated the cost of obesity in a Dr Lilian Kow: Recent market research shows that one of the problems is that patients are not coming to have their weight addressed. This is sometimes because of the perceived cost, particularly of surgery. They do not see the health benefits of surgery or the health benefits of weight loss. What is your view of that?
Lynne Pezzullo: Well I think it is a case of doing some cost benefit analysis. A lot of people who are already obese may have a related condition like diabetes or high blood pressure. That means that their personal costs are already beginning to impact on their lives. They might be spending on average $600 per year in health system expenditures and there is probably a loss of income of on average $1000 a year. There is the cost of their carers and their family taking time off to accompany them to visits to hospitals; there is a productivity cost there. There is also the cost of loss of healthy life, which is around $19,000 per annum. In contrast there is the cost of having the surgery. By having the surgery one can reduce their weight… potentially by 50% or more. So it’s very important to weigh up the benefits from reducing all those costs of obesity itself and obesity related conditions against the costs of surgery. If you compare the costs, the cost benefit analysis can be very positive.
Dr Lilian Kow: How long do you think it takes after surgery for the cost benefit to become evident?
Lynne Pezzullo: The cost effectiveness analysis that we’ve reviewed in the literature shows that bariatric surgery is highly cost effective across all types of bariatric surgery. That means that the surgery eventually pays for itself. For different people that time period can vary. Overall it’s probably about 3.5 years before the bariatric surgery has paid for itself.
Dr Lilian Kow: So Lynne, why should a suitable, clinically obese person spend the money on weight loss surgery?
Lynne Pezzullo: A lot of people look at the up front costs and decide that it needs a lot of thought. They need to think about the financial costs that weight loss surgery can help them avoid by reducing the medical costs associated with the complications of obesity.
Dr Lilian Kow: One of the examples I can give is that a number of my patients are on waiting lists for knee replacements and once they start losing weight from the surgery they no longer need a knee replacement. That is a huge saving not just for the individual, but also for the government and the health fund.
Lynne Pezzullo: There are also the costs that people may not even consider when thinking about the cost of weight loss surgery. We know that risk of cancer is doubled if you are obese and people may not take into account all the complications that they could get if they remain obese… A lot of them are hidden benefits. We know that obesity occurs most in middle age and the reason why there is not a lot of obesity in people in their sixties and seventies is because once people get to that stage they have either lost the weight, or they have died, which is a very sad consequence, but the data supports that mortality from obesity related complications is very high in that age group.
Dr Lilian Kow: Another thing I have also noticed in the population is that people are not aware that obesity shortens their life expectancy.
Lynne Pezzullo: Yes, unfortunately one of the major complications and increased risks for obese individuals is risk of bowel cancer, breast cancer, uterine cancer and kidney cancer and these forms of cancers come with substantial mortality rates. Obesity can shorten your life. Across society the financial costs are about $8.5 billion but for an individual they incur costs of about $19,000 per annum. A large chunk of that cost is actually the value of their loss of healthy life but a substantial proportion is also the out-of-pocket costs that come from being obese and having the various clinical conditions associated with obesity.
The treatment for diabetes, the treatment for cardiovascular disease, the trips to the doctor, the osteoarthritis medication; all those out-of-pocket costs can really add up for the person that is obese. When they are thinking about bariatric surgery they also need to think about how they can save on the other side of the equation.
You have to take a long-term view because weight loss surgery doesn’t pay for itself immediately but it does pay for itself further down the track… On average it takes only about 4 years for the surgery to pay for itself.
They don’t think about lost income. If you are unfortunately diagnosed with bowel cancer or breast cancer, which are partly attributable to being obese, the costs of being off work for many weeks and having the therapies associated with cancer can really hit people’s hip pockets.