Unmet Need for Bariatric Surgery IrSPEN Conference, March 28 th 2017 Professor Patricia M Kearney Professor of Epidemiology, HRB Research Leader patricia.kearney@ucc.ie Department of Epidemiology and Public Health, UCC
78/100,000 10/100,000 44/100,000 In Ireland, fewer than 1/100,000 population publically funded surgeries
Aim 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
Study design – secondary data analysis 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
Eligibility criteria 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
Statistical analysis 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
Criteria 1 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 2 112 (2.06%) participants had a BMI ≥35kg/m² and type 2 diabetes 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)
Eligible population 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: 7,301 patients 11,231 (95% CI: 8,471 – 14,890) achieving good glycaemic control, without requiring medication
Conclusion 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
Implications for policy • 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
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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Health Service Utilisation and Related Costs Associated with Diabetes Attendance at health services in previous 12 months 100 96 87 90 Those with diabetes reported 80 an average of 5.8 GP visits in 70 the past 12 months compared 61 to 3.8 visits in those without % of population 60 diabetes 50 39 40 30 21 20 20 15 12 10 0 GP visit OPD visit Hospital admission A&E admission No diabetes 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 The total incremental costs for the additional health service use associated with diabetes was an estimated € 68,911,819 for a 12-month period.
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