The study has several limitations, Maciejewski acknowledges. It ended in 2006, and since then other types of bariatric procedures, some involving less invasive and more efficient and effective techniques, have been put into practice. Surgeons now have more experience with an increasing number of procedures and quality benchmarks have been established.
It may be that when taking those changes into consideration, the results would be different.
Bariatric surgeries are increasingly considered an effective way to reduce long-term impacts on health. An estimated 109,000 procedures are performed annually in an increasing number of surgical centers, at an estimated average cost of about $26,000 each.
In an accompanying editorial, Harry Sax, MD, of the Department of Surgery at Cedars Sinai Medical Center in Los Angeles, writes that Machiewski's study is "important because total expenditures were higher for the bariatric population, taking into account perioperative expenses. It is unfortunate that a more detailed breakdown of categories of costs could not be performed," to illuminate whether pharmacy costs were and what the quality of life was for those who had the operation compared with those who did not.
"A final point," Sax wrote," is a rather blunt one: Patients who die no longer consume resources," and among those patients who had the surgery, "50 more patients were alive to consume resources during the six years studied."