Similar health costs after gastric bypass, sleeve gastrectomy for adults with diabetes

Key takeaways:

• Adults with type 2 diabetes have similar overall health costs after gastric bypass vs. sleeve gastrectomy.
• Adults who undergo sleeve gastrectomy have higher pharmacy costs after surgery.

Adults with type 2 diabetes have a reduction in overall health care costs after bariatric surgery, regardless of whether they underwent gastric bypass or sleeve gastrectomy, according to study findings published in Obesity.

“We found it surprising that there was no difference in total medical cost reductions between sleeve gastrectomy and gastric bypass for patients with diabetes, as we would have expected greater declines for those undergoing gastric bypass,” Stephanie Argetsinger, MS, MPH, project manager in the division of health policy and insurance research, department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and Kristina H. Lewis, MD, MPH, associate professor of epidemiology and prevention at Wake Forest University School of Medicine, told Healio. “This expectation was based on clinical studies showing higher rates of diabetes remission and more durable remission after gastric bypass, and with the significant reductions in diabetes-specific and overall pharmacy costs and diabetes-specific office visit and lab visits. The somewhat surprising finding of no difference in total costs may be due to the fact that gastric bypass has a higher rate of surgical complications than sleeve gastrectomy in the early years after surgery.”

Argetsinger, Lewis and colleagues conducted a retrospective cohort study using data from the Optum Clinformatics Data Mart database from 2007 to 2019. Adults aged 18 to 70 years with type 2 diabetes who underwent a sleeve gastrectomy or gastric bypass and had data available at least 6 months before and after their procedure were included. Adults who underwent gastric bypass were matched, 1:1, with adults who underwent sleeve gastrectomy by age group, number of and type of type 2 diabetes medications, median daily dose of diabetes medication, presence of type 2 diabetes complications, commercial vs. Medicare Advantage insurance and year group of surgery. Health care costs were collected for each participant. Pharmacy costs included all medication and pharmacy costs, ambulatory care costs included office and laboratory visits, acute care costs included hospital and ED visits and total health care costs was the sum of the other three categories. A differences-in-differences analysis was conducted in 6-month segments to compare costs of gastric bypass and sleeve gastrectomy for up to 4 years of follow-up. Costs were adjusted for 2019 U.S. dollars.

No difference in overall costs

There were 9,608 adults included in the study (mean age, 52 years; 70% women), with 4,804 each in the sleeve gastrectomy and gastric bypass groups. Both groups had a steep drop in type 2 diabetes-specific health care costs after surgery. The change in overall type 2 diabetes costs did not differ between the two groups except at months 25 to 30, where the sleeve gastrectomy group had a $730 higher total costs than the gastric bypass group. Total health care costs increased in the year before surgery for both procedures before flattening after surgery. Overall costs were lower for the sleeve gastrectomy group compared with gastric bypass for the first 18 months after surgery, but no differences were observed after 18 months.

Both type 2 diabetes-specific and overall pharmacy costs dropped in the first year after surgery. After 1 year, total pharmacy costs trended back up and approached baseline at year 4 for adults who underwent a sleeve gastrectomy. Type 2 diabetes-specific pharmacy costs were higher for adults who underwent a sleeve gastrectomy vs. gastric bypass for the entire follow-up period. The largest difference was observed 43 to 48 months after surgery, where the sleeve gastrectomy group had $726 higher type 2 diabetes pharmacy costs than the gastric bypass group. Overall pharmacy costs were also higher among the sleeve gastrectomy group for most of the follow-up period.

“The findings support triaging patients with diabetes to gastric bypass if the primary goal is reduction in medication use,” Argetsinger and Lewis said. “However they do not support total medical cost reductions after gastric bypass compared to sleeve gastrectomy in the first 4 postsurgical years.”

Acute care costs higher with gastric bypass

Both procedures had a large decrease in type 2 diabetes-specific office visit costs after surgery. Type 2 diabetes office visit costs were slightly higher for adults who underwent sleeve gastrectomy compared with gastric bypass, with the largest difference being a $29 higher costs with sleeve gastrectomy 43 to 48 months after surgery. Overall office visit costs were similar between the two procedures during most of follow-up.

Acute care costs increased after both gastric bypass and sleeve gastrectomy relative to baseline. Changes in acute care costs for type 2 diabetes did not differ between procedures except for at months 25 to 30, where the sleeve gastrectomy group had a $363 higher cost than the gastric bypass group. Overall acute care costs 7 to 12 months after surgery were $1,278 higher for adults who underwent gastric bypass vs. sleeve gastrectomy.

Argetsinger and Lewis said with the obesity landscape changing with new medications becoming available, randomized trials are needed to assess the economic impact of bariatric surgery vs. the new agents. They also said studies are needed to analyze the impact of supplementing bariatric surgery with obesity medication.

For more information:

Stephanie Argetsinger, MPH, can be reached at [email protected].

Kristina H. Lewis, MD, MPH, can be reached at [email protected].

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