Cost-Effective for Management of Type 2 Diabetes: Bariatric Surgery

Induced weight loss by surgery is cost-effective relative to conventional therapy for the management of Type 2 diabetes in obese patients, both in the short term and projected over a patient’s lifetime. And the return on investment of surgical therapy is fully recovered through

Induced weight loss by surgery is cost-effective relative to conventional therapy for the management of Type 2 diabetes in obese patients, both in the short term and projected over a patient’s lifetime. And the return on investment of surgical therapy is fully recovered through savings in health care costs.

Results of a 2-year randomized controlled trial indicate that “surgically induced weight loss leads to the remission of Type 2 diabetes in the majority of obese patients,” Catherine L. Keating at Monash University, Australia, and co-authors note.

Using data from that trial, the team estimated the within-trial cost-efficacy of surgically induced remission of Type 2 diabetes. Included were 60 patients with diabetes diagnosed within the previous 2 years and BMIs between 30 and 40. Thirty were assigned to placement of a laparoscopic adjustable gastric band, and 30 were assigned to best available medical management. Costs were reported in 2006 Australian dollars.

Diabetes remission was achieved by 22 patients (73%) treated surgically and 4 patients (13%) treated medically.

Over 2 years, surgical therapy cost an additional $10,000 per patient. Keating’s group estimates that each case of remitted diabetes cost an additional $16,600 over conventional therapy.

However, they note, “the comparable incremental cost-effectiveness ratio for conventional therapy relative to no intervention (no costs and no benefits) over the same time horizon is $25,500 per case of diabetes remitted.”

The authors suggest that “within a 2-year time horizon the surgical therapy program is below the currently accepted cost-effectiveness threshold.”

Keating and her associates developed a Markov model using the same data to extrapolate the costs and outcomes to the lifetime of the trial population.

“Relative to conventional therapy, surgically induced weight loss was a dominant alternative (associated with health care savings and health benefits) for managing Type 2 diabetes in obese patients,” they report.

They calculate that surgical management was associated with health care savings of $2,400 and an additional 1.2 quality-adjusted life years per patient. Moreover, “this analysis suggests that after 10 years the return on investment of surgical therapy is fully recovered through savings in health care costs.”

Diabetes Care April 2009;32:567-574,580-584.