Bottom line costs and benefits of gastric bypass

 The average cost for gastric bypass surgery is about US$25,000 in Florida. This includes the surgeon’s fees, anaesthesia and the hospital stay.

For patients coming from the Cayman Islands to the US, other potential costs include accommodation before and after the hospital stay and car rental. Airline tickets for the patient and a relative could also step up the total price tag.

While doctors say there are many long-term health benefits to this procedure, government insurance seems to be the only company paying for it on a regular basis.

In the last three years, government has paid US$759,000 for 14 patients to have the surgery according to information supplied by the Cayman Islands National Insurance Company through a Freedom of Information request. This averages out to about US$54,000 per patient. It is almost US$30,000 above the average costs in the US for the same procedure.

There are a number of reasons why the average costs could be higher for government coverage said Mark Frye of CINICO. The additional costs could be for patient’s flight or accommodation costs for pre or post-operative visits or other associated with the treatment. Or the surgery costs in the US could have come down over three years.

A detailed financial analysis would be needed on the costs associated with this procedure to really find out what government was paying for in $30,000 differential, said Frye.

But in the private sector, health insurers on island rarely pay for this procedure, says Geoff Scholefield of British Caymanian.

“A lot of it is considered an elective procedure,” says Scholefield. “I suspect that each time it comes up, it is weighed on an individual basis.”

Whether or not insurance covers it, for morbidly patients who are determined and have resources, this surgery has been around for 30 or 40 years. It also has a long track record of success to help people who are 100 or more pounds over their ideal weight and the failure rate is low, explains Dr. Carlos Carrasquilla, a bariatric specialist who treats patients in the Cayman Islands.

“There are so many benefits,” says Carrasquilla. “It decreases mortality, decreases health risks and increases quality of life.

“Most of my patients who have Type 2 Diabetes who have the surgery are in remission. The blood pressure comes down. Hypertension comes down. This is a great thing.”

Gastric bypass is only recommended for people who are morbidly obese, which means 100 pounds above their ideal weight. At this stage of obesity, exercise, diet and medication fail most of the time, says Carrasquilla.

The most commonly done gastric bypass uses a technique called the Roux en-Y. Carrasquilla uses a laparoscopic procedure, making one incision about one inch and six others less than a half inch over the wall of the stomach. He then uses a camera and TV monitor to guide the instruments through the procedure.

This technique divides the stomach into two pouches, one small and the other large. When the procedure is completed, the patient uses the small part of the stomach, which makes the patient feel full quickly, minimising the tendency to overeat.

Most patients lose about 70 per cent of the excess weight within the first year, says Carrasquilla.