Obesity Surgery Pays For Itself In 12 Months,Report says

Failure by the NHS to provide cost-effective surgical treatment for morbid obesity is costing the wider economy hundreds of millions of pounds a year. This is one of the findings of the first ever economic impact assessment of obesity surgery released yesterday (Wednesday 8th September 2010) in a new report by the Office of Health Economics for the Royal College of Surgeons of England, National Obesity Forum, Allergan and Covidien.

The report, entitled Shedding the Pounds, analyses government data, National Institute for Health and Clinical Excellence (NICE) clinical guidelines, and reviews the published medical literature to show that a major increase in the number of bariatric surgery operations would pay for itself in one year by enabling many patients to return to paid employment. The OHE analysis estimates the number of patients getting access to surgery and showed:

- If just five per cent of NICE-eligible patients were to receive bariatric surgery, the total net gain to the economy within three years would be £382m.

- If 25 per cent of NICE-eligible patients were to receive bariatric surgery, the total net gain to the economy within three years would be £1.3bn.

- The UK government could also expect savings in benefit payments in the region of £35m-£150m.

- Direct healthcare cost savings of around £56m per annum to the NHS in reduced prescriptions and GP visits if NICE guidance was followed.

It is now well established that a postcode lottery exists in UK obesity surgery provision. The report also obtained data, under the Freedom of Information Act, which shows that many Primary Care Trusts (PCTs) are either ignoring NICE guidelines and rationing care for all but the most severely ill patients, or offering no provision at all. The findings suggest the situation is likely to get worse, with funding set to be cut even further. The report shows that, of those who responded:

- Half of PCTs use only 'elements' of the guidelines set out by NICE guidance to determine who qualifies for bariatric surgery.

- One in ten PCTs ignore the guidance completely.

- Three quarters of PCTs do not track the outcomes for patients of bariatric operations.

- One third of PCTs said they would be more stringent with patients when applying the rules; and none said that guidance would be applied less stringently - effectively resulting in further cuts.

- Huge variations in the numbers of procedures carried out per year between Trusts, ranging from just a single procedure in one PCT in 2009/10 to 192 in another.

The study did not take into account future obesity related hospital re-admissions which would represent even more savings to the NHS. For example, in 2008/09 the NHS Information Centre found there were almost 103,000 "finished admission episodes" where obesity was a primary or secondary diagnosis - a 25 per cent rise over the previous year.

NICE guidelines clearly state that morbidly obese patients - those with a Body Mass Index (BMI) of 40 or more, or those with a BMI of 35 or more and other illness, including diabetes, hypertension, heart disease and sleep apnoea - have a right to be properly assessed for weight loss surgery, however, many PCTs limit access to surgery by simply raising the bar so that only the most seriously ill patients - those with a BMI of 50 or 60 - qualify for surgery. Surgeons have repeatedly questioned the rationing of treatment in this way as these most obese patients are more likely to suffer post-operative complications than intervening earlier in the disease progression.

Around one million people in England have a BMI that meets NICE criteria with approximately a quarter of those both fit for and wanting surgery - yet only 3,600 NHS weight-loss operations were carried out 2009/10. The rise in obesity is unrelenting and the UK is now the fifth most obese nation in the developed world. In 2008, almost a quarter of the population were considered obese, with the figure set to double by 2050. The direct cost of obesity and related illness to the NHS is £4.3bn per annum - 5 per cent of the total budget.

Mr Peter Sedman, Bariatric Surgeon and Council member of the Association of Laparoscopic Surgeons (ALS) said: Patients do not choose to have surgery because it is an easy option; they have it because all other treatment methods have failed. Surgery can literally transform lives, getting people back to work and contributing fully to society. If we do not continue to put resources into this cost-effective and proven successful method of treatment the financial burden on society and the NHS caused by obesity related illness in years to come will be crippling."

Professor David Haslam, Chair of The National Obesity Forum, said: "Healthcare professionals working in the field of obesity management are calling for the Department of Health to invest in long term strategies ensuring that patients have equal access to treatment by experienced multi-disciplinary teams in well-equipped centres offering full specialist assessment, and appropriate treatment providing safe long-term follow up and emergency re-admission."

John Black, President of the Royal College of Surgeons said: These figures are simply staggering. The NHS can not afford to ignore the mounting evidence that shows that bariatric surgery, for those patients where all other treatments have failed, is not only proven to be successful but also hugely cost effective."

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