Results of a study of long-term health care costs suggest that patients with obesity and type 2 diabetes should be prioritized for weight-loss surgery over those without diabetes in light of cost savings from possible disease reversal following surgery.
“In this study, we report for the first time, to our knowledge, that long-term economic outcomes favor the diabetes subgroup (relative to euglycemia and prediabetes subgroups), adding further evidence to support the prioritization of patients with obesity and type 2 diabetes for bariatric surgery,” the researchers wrote. “We also noted that duration of diabetes was of importance, with a shorter duration being associated with better cost outcomes.”
, PhD, of the clinical epidemiology unit, department of medicine at Karolinska Institutet in Sweden, and colleagues evaluated data from the Swedish Obese Subjects (SOS) study on 1,999 adults who had bariatric surgery and 2,031 who underwent conventional treatment between Sept. 1, 1987, and Jan. 31, 2001, to determine health care costs between the groups.
These participants were divided into the following groups: participants without diabetes who underwent surgery (n = 1,355), participants without diabetes who underwent conventional therapy (n = 1,481), those with prediabetes who underwent surgery (n = 301), those with prediabetes who underwent conventional therapy (n = 290), those with diabetes who underwent surgery (n = 343) and those with diabetes who underwent conventional therapy (n = 260).
In participants without diabetes, drug costs did not differ between the surgery and conventional therapy groups during a mean 15 years. However, over 15 years participants with prediabetes who underwent surgery had lower drug costs compared with those who had conventional therapy (P = .007) and the same was found for those with diabetes (P < .0001).
Inpatient costs over 15 years were higher among all glucose subgroups for those who underwent surgery (P < .0001 for each) compared with conventional therapy.
Participants without diabetes and those with prediabetes who underwent surgery had higher total health care costs compared with those who had conventional care (P < .0001 for both); no difference was found between treatment groups for participants with diabetes.
“In this study, we show that for obese patients with type 2 diabetes, the upfront costs of bariatric surgery seem to be largely offset by prevention of future health care and drug use,” the researchers wrote. “The finding of cost neutrality is seldom noted for health care interventions, nor is it a requirement of funding in most settings. Usually, buying of health benefits at an acceptable cost … is the economic benchmark adopted by payers when new interventions are assessed. Bariatric surgery should be held to the same economic standards as other medical interventions.”
In an accompanying editorial, Ricardo Cohen, MD, of the Center for Obesity and Diabetes at the Hospital Oswaldo Cruz in Brazil, wrote that BMI should not be the only indication for surgery.
“Thus, individuals that do not have their diabetes under control with the best pharmacological approach and lifestyle interventions should be prioritized for bariatric surgery, irrespective of their BMI,” he wrote. “Those with a short history of diabetes should be prioritized the most because they will probably need fewer drugs and will be less likely to develop microvascular and macrovascular complications than will those with a long history of the disease as fewer complex and expensive medical resources will be needed.” – by Amber Cox
Cohen reports no relevant financial disclosures. Neovius reports various financial ties with Abbott, AstraZeneca, Cambridge Weight Plan, Itrim International, Novo Nordisk, Pfizer, Sanofi-Aventis, Strategic Health Resources, Studentlitteratur, and the Swedish Scientific Research Council.