Possible Consequences of the New Operation Criteria for Bariatric Surgery in Switzerland

In 2009, about 5.1 Mio persons aged 18–65 years lived in Switzerland [2]. As shown in Table 1, about 2% of adults can be expected to have a BMI≥35 kg/m2 [3, 4]. As is the case in most countries, in Switzerland, obesity prevalence is underestimated by studies using self-reports [5]. Nevertheless, the estimate from the study with measurements may be considered as conservative, because the prevalence has probably increased since 2003. Moreover, non-participants may be more frequently obese than participants leading to an underrepresentation of obese persons in health surveys [6]. Based on an expected prevalence of 2%, about 100,000 are likely to fulfil the recently introduced criteria. Since in Switzerland health insurance is mandatory, the new criteria could result in an increase of health expenditures. The average costs of a surgical intervention are between 12,000 and 25,000 CHF (Swiss Franc, US $13,600–26,300) [7]. Aftercare costs decrease from 3,500 CHF in the first postoperative year to 2,500 in the second year to 1,000-1,500 CHF thereafter [1, 7]. While the prevalence of BMI 25–34 kg/m2 is probably stagnating or even decreasing in Switzerland [8], this may not be the case for BMI≥35 kg/m2 (Table 1). A further increase of expenditures related with bariatric surgery interventions is therefore possible. However, direct and indirect costs associated with obesity are substantial in Switzerland [9]. Possibly, between 15% and 20% of potential candidates for bariatric surgery have diabetes (Table 1). Surgical interventions are generally “cost-effective” after 4–5 years [1, 7]. Therefore, on the long run, the changed criteria could attenuate further increase in health expenditures. Moreover, before introduction of the new criteria, no adequate therapy could be offered to many patients with BMI 35–39 kg/m2.