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Diabetes Patients with Obesity Should Have Increased Bariatric Surgery Priority

Benefits of surgery result in substantially lower healthcare costs for diabetic patients.

Bariatric surgery is a procedure done to induce weight loss in patients with obesity. The weight loss typically comes with overall health benefits such as lowered risk of heart attack, stroke, and diabetes. In many patients, bariatric surgery can reverse type 2 diabetes or prediabetes.

Researchers in Sweden have found that this results in substantially lower healthcare expenditures for diabetes patients with obesity. The prospective study examined 2,010 adults who underwent bariatric surgery as well as 2,037 controls who underwent conventional non-surgical obesity treatment. The patients were treated between 1987 and 2001.

Patients in the surgical group had higher inpatient costs, and there was no difference in outpatient costs between the groups. However, drug costs over 15 years were lower for surgical patients who were diabetic or who had prediabetes. Prediabetes patients who underwent the surgery had drug costs of $10,194 versus the conventional treatment group’s costs of $13,186. Surgical patients with type 2 diabetes had drug costs of $14,346 versus $19,511 in the conventional treatment group. These drug savings ameliorate the higher upfront costs for the surgery. The study did not examine any outcomes aside from cost.

The decrease in drug costs is likely linked to prevention or remission of diabetes induced by the surgery’s weight loss.

The results of this study suggest on a pharmacoeconomic basis that obese patients with type 2 diabetes or prediabetes should be prioritized candidates for bariatric surgery due to the associated decrease in drug costs. In contrast with the study’s recommendations, priority for bariatric surgery is often based on BMI: higher BMI patients will have priority over those with lower BMIs. Clinicians and insurers should consider uncontrolled diabetes as a factor as well due to the decrease in drug costs.

Practice Pearls:

  • Bariatric surgery has positive healthcare outcomes for patients with obesity, including lowered risk of heart disease or diabetes.
  • Patients with type 2 diabetes or prediabetes who underwent bariatric surgery had lower drug costs over 15 years than patients who underwent conventional obesity treatment.
  • The authors of the study recommend that diabetes status should be a factor in determining bariatric surgery priority due to the reduced costs seen in these patients.

Keating C, Neovius M, Sjöholm K et al. Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study. The Lancet Diabetes & Endocrinology. 2015. doi:10.1016/s2213-8587(15)00290-9.