Bariatric Surgery and Weight Loss Drugs: A Cost-Effective Duo for Weight Control

A study presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco suggests that newer weight loss medications are only cost-effective in the long run when combined with bariatric surgery. Furthermore, another study from the meeting indicates that this increasingly popular category of weight loss drugs, known as glucagon-like peptide-1 receptor agonists, is safe and may offer a novel strategy for treating obesity before undergoing bariatric surgery (1^✔ ✔Trusted Source
Comparative Cost-Effectiveness Analysis of Bariatric Surgery and GLP-1 Receptor Agonists for the Management of Obesity

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Key Takeaways

• Two recent studies examine the financial implications of new weight loss medications and their use before bariatric surgery.
• Long term, the cost-effectiveness of bariatric surgery is greater than that of GLP-1 RA weight loss drugs alone, but a combination of the two treatments is more cost-effective than surgery alone.
• Using weight loss medications in the year leading up to bariatric surgery does not correlate with poorer health outcomes within the first month post-surgery, nor does it result in significantly different weight loss after one year.

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From Diabetes Treatment to Weight Loss Solution

Originally used to treat Type 2 diabetes, liraglutide (branded as Saxenda) and, more recently, semaglutide (branded as Wegovy) injections were approved by the U.S. Food and Drug Administration (FDA) for weight loss in patients with obesity or overweight and at least one weight-related health condition. These prescription medications lead to weight loss by mimicking hormones in the body that suppress appetite and increase a sense of fullness.

People must use a GLP-1 RA indefinitely to maintain weight loss, said the first study’s lead author, Joseph Sanchez, MD, a general surgery resident at Northwestern Medicine, Chicago.

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Insurance Coverage Challenges

“GLP-1 RA are lifelong medications for obesity management that are not always covered by insurance and can cost some people $800 to $1,200 per month out-of-pocket,” Dr. Sanchez said. “But we didn’t know how these medications compared in cost-effectiveness with the gold-standard obesity management option, bariatric surgery.”

Anne Stey, MD, FACS, the study’s senior investigator and an assistant professor of surgery at Northwestern University Feinberg School of Medicine, Chicago, emphasized the importance of this information.

“As evidence of health benefits of GLP-1 RA continues to come out, insurance companies will have to decide whether they will cover these medications and in which case scenarios,” Dr. Stey said. “Understanding if and how these different obesity management options are cost-effective is critical to ensure as many people have access to these medications as possible.”

Cost-Effectiveness Analysis

Dr. Sanchez and colleagues performed a cost-effectiveness analysis of GLP-1 RA therapy alone and bariatric surgery alone — either gastric bypass or sleeve gastrectomy. They also studied the cost-effectiveness of bariatric surgery in conjunction with treatment with GLP-1 RA to prevent weight regain (2^✔ ✔Trusted Source
The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis

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Assessing Quality-Adjusted Life Years (QALY)

The investigators predicted the costs of each of these treatments until death (up to 50 years) for thousands of patients from different clinical trial findings around the United States. The researchers considered a treatment to be cost effective if the total cost was less than $100,000 per quality-adjusted life year (QALY). A QALY is one adequately healthy year of life a patient could gain from treatment.

Comparing Costs: Medications vs. Bariatric Surgery

At $17,400 to $22,850, the estimated cost of bariatric surgery exceeded the average yearly cost of $9,360 to $16,200 for GLP-1 RA, the researchers found. However, compared with these medications alone, bariatric surgery added approximately two QALYs and would save a patient more than $9,000 to earn a year of quality life. GLP-1 RA combined with bariatric surgery would save more than $7,200 per QALY versus surgery alone and added more than five QALYs.

“Undergoing bariatric surgery is more cost-effective in the long run than maintaining these medications for the remainder of an individual’s life,” Dr. Sanchez said. “The critical role for these medications from a cost-effectiveness perspective is to use these medications to address weight regained after bariatric surgery.”

These results could change later, he said, if the cost of these medications decreases or if new, lower-priced weight loss medications become available. However, he added that the cost would have to decrease by nearly 75%.

The Benefits of Pre-Surgery Weight Loss Medications

A study from Indiana University (IU) School of Medicine in Indianapolis found that the use of GLP-1 RA in the year before bariatric surgery has increased more than threefold since 2018 — from 8% to 24%.

Some researchers have proposed using GLP-1 RA medications before bariatric surgery to help lower the weight of patients with a body mass index (BMI) greater than 50, which can make the operation more complex, said Tarik Yuce, MD, MS, the study’s senior investigator, an ACS Associate Fellow, and an assistant professor of surgery at IU School of Medicine. A BMI of 40 or greater is considered severe obesity.

“Losing weight can perhaps make the surgery easier and safer, so that’s an exciting potential avenue for these medications,” Dr. Yuce said.

Evaluating Safety of Preoperative Medication

According to Qais AbuHasan, MD, an IU School of Medicine research fellow and the study’s lead author, the study’s purpose was to determine whether any adverse effects occur with the use of GLP-1 RA before bariatric surgery. Patients may have used the medication to treat diabetes, to lose weight, or both.

The research team studied outcomes for 2,169 patients who underwent bariatric surgery at three IU-affiliated hospitals from 2018 through 2023. Outcomes evaluated included differences in 30-day hospital readmissions, emergency department visits, and complications for patients who preoperatively used GLP-1 RA (293 patients) and patients who did not (1,876 patients).

Study Conclusions: No Significant Differences Observed

Dr. AbuHasan reported no statistically significant differences between treatment groups in these short-term outcomes or the percentage of total weight loss one year after surgery. Patients who used GLP-1 RA preoperatively lost a median of 25.5% of their total weight one year after the operation, and patients who did not use these medications lost 27.3% of their total weight.

“It might be safe to use GLP-1 RA in the preoperative period,” he concluded. “But we need to investigate further to determine whether factors such as the dose and duration of treatment may or may not lead to any differences in outcomes.”

References:

1. Comparative Cost-Effectiveness Analysis of Bariatric Surgery and GLP-1 Receptor Agonists for the Management of Obesity - (https://www.surgery.northwestern.edu/docs/edelstone-bendix-research-poster/2024-posters/Sanchez-Joseph.pdf)
2. The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis - (https://perioperativemedicinejournal.biomedcentral.com/articles/10.1186/s13741-024-00439-y)

Source-Eurekalert