Diabetics Should Be Prioritized for Bariatric Surgery

Researcher at the University of Gothenburg (Sweden), Karolinska Institutet (Solna, Sweden), and other institutions conducted a prospective study to examine the long-term effect of bariatric surgery on healthcare costs, if obese patients were classified according to their diabetes status, rather than their body-mass index (BMI). The study included 2,010 adults participating in the Swedish Obese Subjects (SOS) study who underwent bariatric surgery at 25 Swedish surgical departments and 480 primary health-care centers between 1987 and 2001.

The results showed that the accumulated drug costs over the 15 year period did not differ between the surgery and control group in patients without diabetes at the time of surgery, but were on average USD 3,329 lower in surgery patients who had prediabetes and USD 5,487 per patient with diabetes. Hospital costs, however, were higher in all the patients who underwent surgery, but no differences in outpatient costs were observed.

When compared with patients treated conventionally, total healthcare costs—surgery, inpatient and outpatient hospital care, and prescription drugs—were higher in surgery patients who did not have diabetes at the beginning of the study (by USD 22,390 per patient) or who had prediabetes (USD 26,292), but not in patients with diabetes. The researchers surmised that it was most likely because the remission of diabetes that often occurs after bariatric surgery means that patients need fewer diabetes medications and hospital appointments in the subsequent years. The study was published on September 17, 2015, in the Lancet Diabetes & Endocrinology.

“We show that for obese patients with type 2 diabetes, the upfront costs of bariatric surgery seem to be largely offset by prevention of future health-care and drug use,” said study coauthor Martin Neovius, MD of the Karolinska Institutet. “This finding of cost neutrality is seldom noted for health-care interventions, nor is it a requirement of funding in most settings. Bariatric surgery should be held to the same economic standards as other medical interventions.”

The growing global epidemic of obesity and the lack of effective long-term dietary modification options make it likely that surgical treatment will become increasingly common for obesity, and that more diabetic patients will be initiating discussions with their primary care physicians regarding the benefits and risks of such procedures.

Related Links:
University of Gothenburg
Karolinska Institutet