Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study

Abstract

Background Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term healthcare costs is unknown. Methods The Swedish Obese Subjects (SOS) study is a prospective, matched, controlled intervention study conducted in the Swedish healthcare system including 2010 adults who underwent bariatric surgery and 2037 contemporaneously matched controls recruited between 1987 and 2001. Prescription drug costs were retrieved via questionnaires and the nationwide Swedish Prescribed Drug Register. Data on hospital admissions and outpatient visits were retrieved from the Swedish National Patient Register. The sample linked to register data (n=4030; 2836 euglycemic; 591 prediabetes; 603 diabetes) was followed over up to 15 years. Mean differences were adjusted for baseline characteristics. Findings Drug costs did not differ between the surgery and control group in the euglycemic subgroup (adjusted mean difference −$225; 95%CI −2080 to 1631), but were lower in surgery patients in the prediabetes (−$3329; 95%CI −5722 to −937) and diabetes subgroups (−$5487; 95%CI −7925 to −3049). Greater hospital costs were observed in the surgery group for the euglycemic ($22,931; 95%CI 19,001–26,861), prediabetes ($27,152; 95%CI 18,736–35,568) and diabetes subgroups ($18,697; 95%CI 9992–27,402). No differences in outpatient costs were observed. Total healthcare costs were higher in surgery patients in the euglycemic ($22,390; 95%CI 17,358–27,423) and prediabetes subgroups ($26,292; 95%CI 16,738–35,845), while no difference was detected between treatment groups in patients with diabetes ($9081; 95%CI −1419 to 19,581). Interpretation Long-term healthcare cost results support prioritizing obese patients with diabetes for bariatric surgery.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…73 Two other recent large studies failed to demonstrate a cost benefit for bariatric surgery versus matched patients over 6 years of follow-up 74,75 ; however, another 2 studies showed cost savings for bariatric surgery among patients with DM at baseline. 76,77 …”

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

“…C: Dot plot comparing baseline with final HbA 1c levels following surgery in each of the 11 RCTs displayed in Fig. 3A. studies, support cost-effectiveness of bariatric/metabolic surgery, especially in patients with T2D (37). Cost per qualityadjusted life-year (QALY) of bariatric/ metabolic surgery in general is approximately $3,200-$6,300, well below the range of $50,000/QALY deemed appropriate for coverage (36,67).…”

“…A long-term assessment of health care costs in subjects enrolled in the Swedish Obese Subjects (SOS) study was performed according to diabetes status at baseline, providing a comparison of drug-related and total health care expenditure for patients who undergo bariatric surgery versus matched control participants over 15 years (37). Drug costs were lower for the surgery patients who started with prediabetes ($3,329 less per patient) or diabetes ($5,487 less per patient).…”

“…Uncertainty also exists about the costeffectiveness or savings of bariatric/ metabolic surgery for patients with lower BMIs. On the other hand, most studies so far examined patients receiving bariatric surgery primarily for severe obesity and with a relatively low prevalence of diabetes; these studies might underestimate economic value of surgery because cost-effectiveness appears to be greater in obese patients with diabetes at baseline compared with those without diabetes (37). Additional cost-effectiveness studies of specific metabolic surgery procedures in different clinical scenarios, and based on RCT data, would greatly facilitate the decision-making process of policymakers determining insurance coverage for surgical treatment of T2D.…”

“…Further research on mechanisms of action of these procedures (5,6,(26)(27)(28)(29)(30)(31)(32)(33)(34) has corroborated evidence in animal studies demonstrating an important role for the GI tract in glucose homeostasis (35), providing a biological rationale for the use of GI-based interventions to treat T2D. Available data, based predominantly on modeling studies, suggest that bariatric/metabolic surgery is also cost-effective, especially in patients with diabetes (36,37).…”