Bariatric Surgery Cuts Diabetes Drug Use and Costs

Obese patients who undergo weight-loss surgery reduce their diabetes medications by almost three-fourths and cardiac drugs by nearly half after 4 years, according to a new study. And they end up spending much less on these medications.

Significant medication cost reductions were achieved in patients undergoing bariatric surgery in comparison with a nonsurgical control group.

“Given that these cost savings are achieved at 1 year post-surgery and sustained at 4 years post-surgery, it is likely that additional medication cost savings may be maintained,” stated lead author John M. Morton, MD, Chief, Bariatric and Minimally Invasive Surgery, Stanford University School of Medicine, Stanford, California. “As patients lose weight after surgery, they typically see significant improvements in many obesity-related conditions, including diabetes, hypertension, and heart disease, while similar patients who don’t have surgery often see their conditions become worse.”

Dr Morton and colleagues used data obtained from the Truven Health MarketScan® Databases for 2007-2012 to propensity-score match the health claims of 2700 laparoscopic gastric bypass and gastric band patients before and after surgery with 2700 nonsurgical patients matched for body mass index and health status with 4-year follow-up.

Accounting for preoperative costs and patient characteristics, bariatric surgery patients had 22.4% lower pharmacy costs compared with nonsurgical controls in the 4-year period after surgery.

“At 4 years after surgery, there was a sustained decrease in medication cost for the surgery group compared to the control group with $8,411 and $9,900 in overall pharmacy costs,” stated Dr Morton. “Specifically, in the 1-year prior to surgery, the surgery and control group consumed $3,098 and $2,303 in overall pharmacy costs. One year following surgery, there was a reversal between the surgery and control group with $2,209 and $2,407 in overall pharmacy costs, respectively.” Medication costs are particularly sensitized to changes in body weight, he noted.

There was a 73.7% reduction in the number of antidiabetic medications taken by surgical cases compared with controls in the 4-year postsurgery period and a 47% reduction in antihypertensive and cardiac medications.

About 179,000 patients had bariatric surgery last year, at a cost ranging anywhere from $17,000 to $30,000, depending on surgical method and geography, according to the American Society for Metabolic and Bariatric Surgery. A study in 2008 calculated that the medical cost savings, between less frequent doctor visits and less use of costly drugs for obesity-related diseases, offset the price of gastric bypass, one of the most common methods of bariatric surgery, within 2 to 4 years.

“The health and economic case for bariatric surgery is compelling, yet we are only performing these operations on less than 1% of potential candidates,” said Raul Rosenthal, MD, director of the Bariatric and Metabolic Institute at Cleveland Clinic Florida. “We need to make rational choices when it comes to health care and the right choice for patients with obesity may be bariatric surgery.”

Dr Morton presented the results of the study (Abstract A103) at the 31st Annual Meeting of the American Society for Metabolic and Bariatric Surgery in San Diego during ObesityWeek 2014.