Health care costs lower for patients with diabetes in years after bariatric surgery vs. before
Overall health care expenditures decreased to similar extents after Roux-en-Y gastric bypass and sleeve gastrectomy, primarily because of reductions in medication expenses, according to a retrospective cohort study.
Health care expenditures among patients with diabetes decreased substantially after bariatric surgery, a recent study found.
Researchers performed a retrospective cohort study using target-trial emulation to compare health expenditures three years before and five and half years after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy in patients with diabetes at Kaiser Permanente Southern California and Kaiser Permanente Washington. The primary outcomes were total, inpatient, outpatient, and medication expenditures. The results were published Jan. 28 by Annals of Internal Medicine.
Overall, 3,147 patients with diabetes undergoing RYGB and 3,510 undergoing sleeve gastrectomy from 2012 to 2019 were included in the study. Seventy-three percent were female, average body mass index was 43.8 kg/m2, and average age was 50 years. Health expenditures per six-month period decreased by approximately 30% after each type of surgery, from $4,039.06 (95% CI, $3,770.88 to $4,326.31) three years before RYGB to $2,441.13 (95% CI, $2,151.07 to $2770.30) five and a half years afterward and from $3,918.37 (95% CI, $3,658.75 to $4,196.40) three years before sleeve gastrectomy to $2,658.15 (95% CI, $2,279.17 to $3,100.16) five and half years afterward.
Total expenditures after surgery were briefly higher in the RYGB group during the first six months due to a higher inpatient admission rate but otherwise did not differ significantly over five and a half years (difference at 5.5 years, −$217.02 [95% CI, −$671.29 to $201.96]). Postsurgical outpatient and medication expenditures did not appear to differ between procedures.
Among other limitations, the study was observational and did not include a nonsurgical control group, the authors noted. They concluded that both RYGB and sleeve gastrectomy significantly reduce health expenditures for patients with type 2 diabetes, with no significant differences between the two over five and a half years of follow-up.
“The substantial cost savings observed are primarily driven by reductions in medication expenditures, highlighting the economic benefits of bariatric surgery in managing diabetes,” the authors wrote. “Future research should focus on identifying whether there are subgroups of patients with [type 2 diabetes] who are more or less likely to experience significant health and economic improvements over time.”