Long-term health care costs higher for GLP-1 vs MBS

Adults with obesity and diabetes face higher health care utilisation costs with GLP-1s treatment compared with Bariatric metabolic surgery (BMS), excluding intervention costs, largely reflecting differences in early clinical trajectories, according to a study by researchers from Israel. These findings suggest that, among patients eligible for both interventions, BMS may confer combined clinical and economic advantages over long-term follow-up.

The study was designed to compare short- and long-term health care utilisation costs among patients with obesity and diabetes treated with GLP-1RAs vs those who underwent BMS. The primary outcome was the overall costs incurred by Clalit Health Services for each patient. The secondary outcomes were the cost of hospitalisations and medications, ambulatory care, emergency department visits, and other costs incurred by Clalit Health Services for each patient.

The overall propensity score–matched study population consisted of 5,442 adults – 2,721 in each group. Participants had severe obesity, type 2 diabetes and suboptimal glycaemic control. Cardiometabolic comorbidity burden was high, with hyperlipidaemia present in 4,262 patients (78.3%) and hypertension in 3,152 patients (57.9%).

During the baseline period (24 months prior to treatment initiation), mean monthly costs incurred by Clalit Health Services were similar between groups, amounting to $260.6 ($497.6) for patients treated with GLP-1s and $253.9 ($423.9) for patients who underwent BMS. During the follow-up period (beginning 6 months after intervention and extending up to 12.5 years, as per study design), mean monthly costs increased in both groups, reaching $415.3 ($746.7) among patients treated with GLP-1s and $304.9 ($628.5) who underwent BMS. The adjusted analysis demonstrated significantly higher total costs for patients treated with GLP-1s compared with those who underwent BMS ($109.0 per patient per month; SE = $17.0; p<0.001).

The overall costs among patients treated with GLP-1s increased steadily during the follow-up period, while costs among those who underwent BMS were stable during the first four years, and increased thereafter, in parallel to the observed cost increase among patients treated with GLP-1s.

“In this large cohort of adults with obesity and diabetes, BMS was associated with lower long-term health care utilization costs than treatment with GLP-1RAs, excluding intervention costs,” the authors concluded. “These economic differences were associated primarily with reduced hospitalisation and medication use and emerged during periods of greater early weight loss and glycaemic improvement after surgery. Clinically, BMS yielded more pronounced early reductions in BMI and HbA1c level, whereas GLP-1RA treatment was characterised by more gradual but sustained changes. These findings suggest that, among patients eligible for both interventions, BMS may confer combined clinical and economic advantages over long-term follow-up.”

The findings were reported in the paper, ‘Long-Term Health Care Utilization Costs of GLP-1RA Use vs Bariatric Metabolic Surgery’, published in JAMA Network Open. To access this paper, please click here