Bariatric surgery lowers health care expenses for adults with type 2 diabetes, obesity
Key takeaways:
- Health care spending per 6-month period declined 5.5 years after bariatric surgery compared with 3 years before surgery.
- Change in health care spending was similar with gastric bypass and sleeve gastrectomy.
Both Roux-en-Y gastric bypass and sleeve gastrectomy reduced health care expenditures after surgery for adults with type 2 diabetes and obesity, according to data published in Annals of Internal Medicine.
Researchers compared health care costs 3 years before bariatric surgery and 5.5 years after surgery in adults with type 2 diabetes and a BMI of 35 kg/m2 or higher in the Kaiser Permanente Southern California and Kaiser Permanente Washington health systems. Health care expenses were similarly reduced with both types of surgery. The only difference seen between the procedures was in the first 6 months after surgery, when adults who underwent gastric bypass had higher health care spending than those who had sleeve gastrectomy.
“These findings support the use of bariatric surgery as an effective weight-loss intervention for adults with diabetes and severe obesity, and highlights the economic benefits of bariatric surgery in managing diabetes and reducing long-term health care costs,” Matthew Maciejewski, PhD, professor in the department of population health sciences at Duke University and senior research career scientist at the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Medical Center, told Healio.
Maciejewski and colleagues analyzed health care spending for 3,147 adults who underwent gastric bypass and 3,510 who underwent sleeve gastrectomy between 2012 and 2019. Outpatient expenses were estimated by multiplying the use of each health care type by its unit cost. Medicare reimbursement based on diagnostic-related groups was used to estimate inpatient expenses. Expenditures were adjusted to 2020 U.S. dollars.
The unadjusted estimated mean cost of gastric bypass was $17,056 when paid for by Medicare and $29,953 when paid for by commercial insurance. Sleeve gastrectomy cost a mean $15,963 with Medicare coverage and $28,642 with commercial insurance. The cost of bariatric surgery was not included in the calculation of health care expenditures before and after surgery, Maciejewski said.
Total health care expenses decreased similarly in both groups. Those who had gastric bypass had a decline in expenditures from $4,039.06 per 6-month period before surgery to $2,441.13 after surgery. The sleeve gastrectomy group had a decrease in total expenses from $3,918.37 per 6-month period before surgery to $2,658.15 after surgery. The only time period when total expenses differed between bariatric surgery types was during the 6 months after surgery, in which adults undergoing gastric bypass had more expenses compared with the sleeve gastrectomy group (difference, $564.32; 95% CI, 232.6-895.2).
“There were no significant differences in long-term health expenditures between gastric bypass and sleeve gastrectomy, despite previous research suggesting greater weight loss and higher reoperation rates with gastric bypass,” Maciejewski said. “This suggests that both procedures are equally effective in reducing long-term health care costs for patients with type 2 diabetes.”
Maciejewski noted the drop in total health care expenses was mostly due to decline in medication expenditures. Medication spending dropped from $2,200 to $2,300 per 6-month period 2 to 3 years before surgery in both groups to approximately $1,000 per 6 months after surgery.
Both surgery types had a decline in outpatient expenditures, from a peak of about $1,900 in the 6 months before surgery to approximately $800 per 6-month period in the 2 years after surgery and about $600 per 6-month period 3 to 5.5 years after surgery. Inpatient expenditures widely varied before and after surgery in both groups. Inpatient expenses ranged from $236 to $1,037 per 6-month period before sleeve gastrectomy and increased to between $705 and $1,281 after surgery. For those undergoing gastric bypass, presurgical inpatient spending ranged from $227 to $827 per 6-month period. That figure increased to a range of $693 to $1,273 per 6-month period after surgery.
“Future research should focus on identifying subgroups of patients with type 2 diabetes who may experience greater health and economic benefits from bariatric surgery,” Maciejewski said. “Additionally, longer-term studies are needed to determine the durability of these findings beyond 5 years of follow-up.”
For more information:
Matthew Maciejewski, PhD, can be reached at mlm34@duke.edu.
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