Unmet Need for Bariatric Surgery

IrSPEN Conference, March 28th 2017

Professor Patricia M Kearney Professor of Epidemiology, HRB Research Leader

patricia.kearney@ucc.ie

Department of Epidemiology and Public Health, UCC

44/100,000

10/100,000

78/100,000

In Ireland, fewer than 1/100,000 population publically funded surgeries

To estimate the number of people potentially eligible for bariatric surgery in Ireland based on established clinical criteria

To refine the number by identifying those with high morbidity, mortality and healthcare cost, that respond best to bariatric surgery

Aim

Participants completed a computer-assisted personal interview which included questions on self-report doctor diagnosis of chronic conditions

Trained nurses objectively measured participants’ weight and height These measures were used to calculate BMI

Study design – secondary data analysis

Criteria 1: BMI ≥40kg/m² or BMI ≥35kg/m² and type 2 diabetes OR hypertension OR sleep apnoea OR MI

Criteria 2: BMI ≥35kg/m², type 2 diabetes and elevated urine albumin creatinine ratio OR retinopathy OR neuropathy OR MI OR peripheral vascular disease

Eligibility criteria

The number of participants meeting the eligibility criteria for each analysis were expressed as a percentage with corresponding 95% confidence intervals, using Poisson regression

Prevalence estimates were applied to the most recent Irish census figures (2011) to estimate absolute numbers meeting these criteria

Based on evidence from the UK national registry of bariatric surgical patients, a diabetes remission rate of 65% was applied to model the number of people with type 2 diabetes and microvascular complications (criteria 2) with potential remission of diabetes following surgery

Statistical analysis

Condition N % (95% CI)

BMI ≥40kg/m² 145 2.66 (2.25, 3.13)

BMI ≥35kg/m² and:

Type 2 diabetes 112 2.06 (1.70, 2.49)

Hypertension 336 6.08 (5.43, 6.79)

Previous MI 37 0.67 (0.48, 0.94)

Sleep apnoea 119 2.19 (1.81, 2.65)

Any 444 7.97 (7.23, 8.78)

Criteria 1

Condition N % (95% CI)

Previous MI 15 0.29 (0.17, 0.50)

Protein in urine 14 0.25 (0.15, 0.41)

Retinopathy 17 0.36 (0.22, 0.58)

Neuropathy 21 0.39 (0.25, 0.60)

Peripheral vascular disease 10 0.19 (0.10, 0.35)

Any 50 0.97 (0.73, 1.28)

112 (2.06%) participants had a BMI ≥35kg/m² and type 2 diabetes

Criteria 2

The number of people aged 50 years or older in Ireland, in 2011, with potential indication for bariatric surgery under criteria 1 was:

92,573 (95% CI: 83,978–101,981) The number of people aged 50 years or older in Ireland, in 2011, with potential indication for bariatric surgery under criteria 2 was:

11,231 (95% CI: 8,471 – 14,890) 7,301 patients achieving good glycaemic control, without requiring medication

Eligible population

A substantial proportion of older Irish adults are potentially eligible for bariatric surgery

With an estimated 1/100,000 population publically funded surgeries taking place annually, our findings indicate that current public service provision of bariatric surgery in Ireland meets much less than 0.1% of the need

A strategy to develop and expand the provision of bariatric care is urgently needed

Conclusion

• Urgent need for the provision of clinical and cost-effective interventions to treat people with severe obesity

• One strategy to limit the budget impact is to focus on the 0.97% of patients, eligible under criteria two, that have very large and immediate impacts on their health and healthcare cost

• The provision of bariatric surgery to those in greatest need thus has the potential to improve both patient outcomes and reduce direct healthcare expenditure quickly

Implications for policy

Acknowledgements

Ms Kate O’Neill Dr Sheena McHugh Dr Tony Fitzgerald Dr Francis Finucane Professor Carel le Roux Professor RoseAnne Kenny The Irish Longitudinal Study on Ageing HRB Research Leader Award

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2. Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond) [Internet]. 2013;37(6):889–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22986681\nhttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC352764

3. Basterra-gortari FJ, Beunza JJ, Bes-Rastrollo M, Teledo E, Garcia-Lopez M, Martınez-Gonzalez MA. Increasing Trend in the Prevalence of Morbid Obesity in Spain : From 1 . 8 to 6 . 1 per Thousand in 14 Years. Rev Esp Cardiol. 2011;64(5):424–6.

4. NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants. Lancet [Internet]. NCD Risk Factor Collaboration. Open Access article distributed under the terms of CC BY; 2016;387(10027):1513–30. Available from: http://dx.doi.org/10.1016/S0140-6736(16)00618-8

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Attendance at health services in previous 12 months

87

39

12 15

96

61

20 21

0

10

20

30

40

50

60

70

80

90

100

GP visit OPD visit Hospital admission A&E admission

% o

f p

op

ula

tio

n

No diabetes Diabetes

Those with diabetes reported an average of 5.8 GP visits in the past 12 months compared to 3.8 visits in those without diabetes

Health Service Utilisation and Related Costs Associated with Diabetes

• Diabetes diagnosis in males independently associated with an additional 1.70 GP visits per annum, and 1.14 visits in females

• Diabetes was independently associated with a 57% increase in hospital admissions among males and a 48% increase in females

Health Service Utilisation and Related Costs Associated with Diabetes

The total incremental costs for the additional health service use associated with diabetes was an estimated €68,911,819 for a 12-month period.