In patients with type 2 diabetes, Roux-en-Y gastric bypass and sleeve gastrectomy for weight loss may be effective for reducing long-term health care costs, a study from Duke University School of Medicine and Kaiser Permanente has found. The investigators reported that patients who underwent either procedure experienced significant decreases in overall health care costs afterward. However, there were no differences in costs between the two groups of patients except for a transient difference in the first six months post-surgery.

“This was a head-to-head comparison of costs before and after surgery of the two most common procedures for bariatric surgery. The cost reductions were similar for both the procedures, and they were driven by a reduction in medication expenses,” Dr Matthew Maciejewski, Duke University, Durham, NC, the corresponding author of the study and a professor in the Department of Population Health Sciences at Duke University School of Medicine. He is also a senior research career scientist in the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Medical Center. “The cost reductions were similar for both the procedures, and they were driven by a reduction in medication expenses.”
The retrospective cohort study analysed health care costs three years before and five and a half years after bariatric surgery. The researchers studied data about costs for medications and inpatient and outpatient care from 6,657 patients (RYGB, n=3147 or SG, n=3510) with type 2 diabetes at Kaiser Permanente Southern California and Kaiser Permanente Washington between January 2012 and December 2019.
Characteristics of patients undergoing RYGB and SG were well balanced after weighting; 73% were female, average body mass index was 43.8kg/m2, and average age was 50 years. Expenditures per six-month period decreased by about 30% for both groups, from US$4039.06 (95% CI, US$3770.88 to US$4326.31) three years before to US$2441.13 (CI, US$2151.07 to US$2770.30) 5.5 years after RYGB and from US$3918.37 (CI, US$3658.75 to US$4196.40) three years before to US$2658.15 (CI, US$2279.17 to US$3100.16) 5.5 years after SG.
Total expenditures after surgery did not differ between groups through 5.5 years (difference at 5.5 years, −US$217.02 [CI, −US$671.29 to US$201.96]) except for the first six months, when expenditures were transiently higher in the RYGB group (difference, US$564.32 [CI, US$232.60 to US$895.20]), driven by a higher inpatient admission rate.
Otherwise, postsurgical outpatient and medication expenditures did not appear to differ between RYGB and SG.
Maciejewski said the study team plans to examine subgroups of bariatric surgical patients to find out if certain groups have greater potential for cost savings with each type of procedure, and to compare surgical patients to nonsurgical patients.
The findings were featured in the paper, ‘Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy’, published in the Annals of Internal Medicine. To access this paper, please click here (log-in maybe required)
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