Lancet Study Evaluates Cost-Effectiveness of Bariatric Surgery

Bariatric surgery makes more sense for patients with type 2 diabetes (T2D) because the procedure could result in the reversal of their diabetes; thus, these patients would be less likely to need expensive therapies or treatment for complications.

These findings, appearing today in the journal The Lancet Diabetes & Endocrinology, come from the Swedish Obese Subjects study, and examined the measures by which health systems evaluate who should receive surgery to reverse obesity. Looking at cost-effectiveness based on diabetes status, rather than just a person’s body mass index (BMI), makes more sense that looking at BMI alone, according to the findings and an accompanying commentary.

The SOS study evaluated the cost-effectiveness of bariatric surgery, compared with conventional therapy, on healthcare costs in obese patients using real-world data, which had not been done previously.

Researchers, led by Catherine Keating, PhD, and Martin Neovius, PhD, examined data on 2010 adults who had bariatric surgery and 2037 matched controls, who were recruited between 1987 and 2001. Data for total drug costs over a 15-year period were evaluated. Among patients without diabetes at the time of surgery, long-term therapy costs were the same over the period. However, drug costs were lower for the surgery patients who started with prediabetes ($3329 less per patient) or diabetes ($5487 less per patient). Hospital costs were higher in all patients who had surgery. Outpatient costs were the same.

The study highlights the need to take all future healthcare costs into account, including medication and future complications of diabetes, not just the immediate costs of surgery. Comparisons for total healthcare costs–surgery, inpatient and outpatient costs, and prescription drugs–for the groups were:

·         For patients without any diabetic condition: Costs for the group with surgery were $71,059, compared with $45,542 for the group without surgery;

·         For patients with prediabetes: Costs for the group with surgery were $78,151, compared with $54,864 for patients without surgery;

·         For patients with diabetes: Costs for the group with surgery were $88,572, compared with $79,967 for the patients without surgery.

“To our knowledge, this is the first prospectively controlled study to assess long-term healthcare costs in obesity surgery patients according to their preoperative diabetes status versus matched controls,” the authors wrote.

In an accompanying commentary, Ricardo Cohen, MD, of the Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paolo, Brazil, wrote, “A strong need exists for new guidelines that take into account several other factors–mainly uncontrolled diabetes–in addition to the present ones that are solely BMI based, except for the 2014 National Institute for Health and Care Excellence guidelines that recommend bariatric surgery in patients with diabetes with BMIs of 30-35 kg/m².”

Reference

Healthcare costs over 15 years after bariatric surgery for patients with different base line glucose status: results from the Swedish Obese Subjects study [published online September 16, 2015]. Lancet. 2015. http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00290-9/abstract