Today I was browsing the BBC news pages and came across this article about a report from Imperial College suggesting that perhaps 5% of the UK population might become candidates for bariometric or gastric band surgery. While I find the basis of their calculation debateable as there are differences between recent reductions in childhood obesity and another report based on a survey of doctors' views of the situation.
Nevertheless, it does provide the range of costs that gastric band surgery that are met by the English National Health Service. Usually these are difficult to collate as different hospitals may bid different amounts, under commercial confidentiallity, to the commissioning doctors. You will appreciate that these operations are costly but would be free for patients under the NHS, although the report argues that even the considerable increase they suggest would be cost-effective in the long term.
So I thought it might be informative if I compared the costs to the NHS with the prices charged by hospitals and clinics in the USA. One of those annoying Google ads popped up while I was researching but this time it was useful as it gave a link to a private clinic in the UK offering the same surgery. I can therefore give direct comparisons. As I said, this was the first to pop up so please treat it as an example.
Exchange rates vary but have recently hovered around the £1=$1.60 point so I have used that in the rough equivalents below. My source for US information is again from a randomly googled web site.
Costs.
According to the BBC:
Depending on the complexity of the procedure and the care required after surgery, NHS England says bariatric surgery costs can vary between £3,000 [$4,800] and £11,505 [$18,400].
Gastric band surgery is cheaper than gastric bypass surgery, which is a more complicated and risky operation.
In all these comparisons I have therefore concentrated on band rather than bypass surgery costs.
Surgicare, the private company in the UK, gives quotes for this procedure including an overnight stay and two years' followup. These are split into bands (excuse the pun) for those patients with a Body Mass Index of between 30 and 50 at £4995 [$8000]; BMI between 50 and 60 at £6450 [$10,320] and BMI over 50 at £6950 [$11,120]
The US site gives this advice:
$9,000 USD to $20,000 USD is the pricing range across the country.
$14,000 is the most often quoted average gastric band price.
Cash prices tend to be lower than if insurance pays.
Surgery centers often offer out-patient lap banding procedures which can be less expensive than a hospital.
The site makes it clear that whether consultations, band top ups etc are included in this price depends on the surgeon and the patient should ask beforehand.
A further complexity is the matter of any further costs if complications arise after surgery. Although the NHS costings would include these, the situation in the USA would vary. Neverthless, the situation is fairly clear: even private costs in the UK are less than in the USA by from $1000 to $8,800. At the lowest end, the cost to the NHS is almost half that in the USA.
Patient Selection
Although less so than gastric bypass surgery, gastric band surgery is still an expensive and possibly contraversial procedure for the NHS. It also carries risks, including death. There are therefore some quite strict conditions on which patients are offered the procedure, although the Imperial College report suggests they should be widened. The current guidelines are those issued by the National Institute for Health and Clinical Excellence (NICE) as best practice. The NHS Choices web site advises (bolds mine):
Weight loss surgery, also called bariatric surgery, is used as a last resort to treat people who are dangerously obese (carrying an abnormally excessive amount of body fat).
This type of surgery is only available on the NHS to treat people with potentially life-threatening obesity when other treatments, such as lifestyle changes, haven't worked.
Potentially life-threatening obesity is defined as:
having a body mass index (BMI) of 40 or above
having a BMI of 35 or above and having another serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure
Not surprising as it claims to follow NICE guidelines, the private Surgicare Medical Group's site echoes the NHS advice. Again emphasis mine.
Before undergoing weight loss surgery, it’s important to understand whether or not a weight loss surgical procedure is the right way to deal with your excess weight.
Weight loss surgery should be a solution that you seek after trying conventional weight loss techniques, like dieting and exercise. If these options fail and you need to take radical action, weight loss surgery from SMG can provide long-term help to address the problem.
Remember, weight loss surgery is not a quick-fix solution. At SMG, we offer a comprehensive aftercare programme following weight loss surgery to ensure that you change your eating habits and lifestyle choices to ensure long-term success.
Reassuringly the US web site indicates that patients must qualify for surgery by meeting the conditions set by the National Institute for Health. These are congruent with the NICE guidelines. That is not to say of course that the less scrupulous doctors in private practice in either country would not "stretch" the NIH or NICE guidelines and operate on less overweight patients - that lowest band in the UK worryingly starts at a BMI of 30, 5 less than the minimum recommended by both bodies.
The other cause for concern is whether and how strictly doctors in private practice comply with the other condition, that the patient should have tried other "conventional weight loss techniques". With the NHS system of registering with a GP (primary care physician), such records are easy to access, even for private clinics. That combined with paying for medical care being unfamiliar and not usually taken into account with savings likely means fewer in the UK are likely to attempt this surgery as a short cut. I would be interested for the views of US Kossacks whether this practice is common.