Study finds bariatric surgery less costly than GLP-1s over time

A new real-world analysis of more than 90,000 patients with obesity and type 2 diabetes finds metabolic and bariatric surgery is costs significantly less than weekly injections of GLP-1 drugs over a two-year period, according to research, ‘Understanding insurance-based differential healthcare costs for GLP-1ra versus bariatric surgery (abstract id: 4339)’, presented at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery.

“As GLP-1 use becomes more widespread, understanding their long-term financial impact compared with metabolic and bariatric surgery is increasingly important,” said lead study author, Dr Michael A Edwards, a bariatric surgeon in the Department of General Surgery at the Mayo Clinic in Jacksonville. “The assumption that drugs are more cost-effective because of their lower upfront costs doesn’t hold up when extended over time, and especially when durability, adherence, and payer structure are considered.” 

Data was drawn from the STATinMED RWD Insights all-payor claims database covering patients treated between 2017 and 2023. The study involved nearly 91,000 patients with obesity (BMI 35 or higher) and type 2 diabetes received either GLP-1 therapy or metabolic and bariatric surgery. After propensity score matching, researchers compared 4,931 patients treated with GLP-1s to an equal number of patients who underwent sleeve gastrectomy, and a separate matched group of 4,272 GLP-1 patients to an equal number who underwent gastric bypass.

Researchers from Mayo Clinic Florida and Baylor College of Medicine in Texas found that GLP-1s end up costing thousands more per patient than surgery. In direct comparisons, total costs for GLP-1 treatment were about $17,000 more than sleeve gastrectomy ($58,600 vs. $41,400) and $7,200 more than gastric bypass ($58,600 vs. $51,300) after two years. Total costs, which varied by insurance type, reflect both the costs of the treatments and any expenses associated with subsequently unresolved obesity-related diseases and complications.

Edwards added that it’s important for patients and providers to understand the overall value proposition, which should include consideration of the safety and effectiveness of the treatment, the patient’s overall experience, and the cost of each care option over time.

“Obesity is a chronic disease and treatment decisions must consider long-term outcomes, affordability and sustainability. In this particular study, the more durable and clinically effective treatment -- metabolic and bariatric surgery - is also the more affordable one,” said Dr Richard M Peterson, President, American Society for Metabolic and Bariatric Surgery (ASMBS) and Professor of Surgery at UT Health San Antonio, who was not involved in the study.

The study was carried out in collaboration with the Global Economics and Outcomes Research Group in Intuitive Surgical, Inc. Access to the database was paid for by Intuitive Surgical.