Study strengthens the case for insurers and policymakers to support coverage and improve access to MBS

Metabolic and bariatric surgery (MBS) for teens with severe obesity is cost-effective over ten years, according to an analysis from Ann & Robert H Lurie Children's Hospital of Chicago, IL. While long-term clinical benefits of weight-loss surgery for eligible teens have been well established, and it is recommended by the American Academy of Pediatrics, insurance coverage has been limited and few teens can take advantage of the surgery. This study strengthens the case for insurers and policymakers to support coverage and improve access to the procedure.

"Severe obesity in adolescence is a serious and expensive health problem, and with the high risk for complications like diabetes, the long-term costs can be substantial," said lead author, Dr John Rode, pediatric surgery research fellow at Lurie Children's. "Our study shows that over time, weight-loss surgery emerges as the most cost-effective option when we consider years of better health that it provides, compared to nonsurgical management for teens with severe obesity."

Rode and colleagues built a detailed simulation model that follows teenagers with severe obesity over 10 years and compares two paths - one where they have surgery and one where they do not. The model included real-world data from previous studies on three key aspects of obesity care: what care costs (the surgery itself, follow-up care and the ongoing treatment of obesity-related illnesses), how teens' health changes over time on each path and how those changes affect their quality of life.

Type 2 diabetes was one of the most important factors considered. It is among the most serious and expensive conditions driven by severe obesity, as it often appears early and can last a lifetime. The model accounted for how likely teens are to develop diabetes on each path and how surgery shifts those odds.

"Weight-loss surgery frequently sends type 2 diabetes into remission, sparing patients years of medication, complications and cost," said Rode. "Because diabetes is so expensive to manage over a lifetime, avoiding or reversing it is one of the biggest reasons that surgery provides such great value. Of course, an important caveat is that surgery remains a major case-by-case decision for teens who meet the criteria."

To see how reliable the results were, researchers ran the model 300,000 times, varying the inputs across the full range of real-world possibilities. Using data from the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, the population was a hypothetical cohort of 100 000 adolescents with the following baseline characteristics: age 17 years, body mass index 52.1, 75.0% female, 13.3% with type 2 diabetes, 4.9% with low ferritin, 37.2% with low vitamin D, and 0.4% with low vitamin B12. At 10 years, sleeve gastrectomy was projected to be the cost-effective strategy, with an ICER of $41,164 per QALY gained when compared with no surgery. RYGB yielded the most QALYs, although with a less favourable ICER of $557,751 per QALY gained compared with sleeve gastrectomy. However, in a direct comparison with no surgery, RYGB was estimated to be cost-effective, with an ICER of $50,271 per QALY gained. In sensitivity analyses, sleeve gastrectomy was consistently the cost-effective strategy.

Across those simulations, the pattern held - surgery consistently delivered more years of healthy life, at a cost per year that fell below what health systems consider a good value. That value was strongest for sleeve gastrectomy, which is one of the most common types of weight-loss surgery.

The study concluded that the long-term cost-effectiveness of both sleeve gastrectomy and RYGB as interventions for adolescents with severe obesity, with sleeve gastrectomy emerging as the most cost-effective strategy in a 10-year comparison of sleeve gastrectomy, RYGB and no surgery.

“While the lasting health benefits of MBS are well-established by the Teen-LABS study, significant barriers to its broader adoption remain. Overcoming these challenges will require policy-level action, including expanding insurance coverage to include MBS in all medically appropriate adolescents with severe obesity,” the authors concluded. “Our analysis contributes further evidence supporting the long-term cost-effectiveness of MBS in this population to guide further health care policy decisions aimed at improving outcomes for adolescents with severe obesity.”

"Our model did not consider treatment with GLP-1s because long-term data are lacking for these therapies and they are typically prescribed for teens with less severe obesity, making it difficult to make robust comparisons at this time," explained Rode. "However, as long-term GLP-1 clinical outcome and cost data emerge, our study can serve as a benchmark for comparison with weight-loss surgery."

The findings were featured in the paper, ‘A 10-Year Cost-Effectiveness Analysis of Metabolic and Bariatric Surgery in Adolescents’, published in JAMA Network Open. To access this paper, please click here