Bariatric Surgery Highly Cost-effective Treatment for Type 2 Diabetes in the Obese

Bariatric surgery is an especially cost-effective therapy for managing type 2 diabetes in moderately and severely obese patients. These findings and others were presented today at the 2nd World Congress on Interventional Therapies for Type 2 Diabetes, hosted by New York-Presbyterian Hospital and Weill Cornell Medical College.

Cost effectiveness is central to the larger issue of access to surgical treatment of diabetes, said Francesco Rubino, MD, director of the Congress and director of gastrointestinal metabolic surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

Today, an estimated 285 million people around the globe suffer from type 2 diabetes, and the number is expected to double by 2030, noted Rubino, who also serves as associate professor of surgery at Weill Cornell Medical College. “The need for effective, potentially curative therapies is urgent,” Rubino said in a statement.

According to an analysis presented today at the congress by an Australian researcher, bariatric surgery to treat type 2 diabetes has been demonstrated to be very cost effective in the countries in which this research has been done—the United States, United Kingdom, Australia, and in some European settings.

The review also found that several studies have determined that bariatric surgery was not only cost effective, but cost saving, says Catherine Keating, a senior research fellow from the Health Economics Unit at Deakin University in Melbourne, who made the presentation.

For obese patients diagnosed with type 2 diabetes during the two years prior to bariatric surgery, one study found that the upfront costs of surgery would be fully recouped through the prevention of future health care costs to treat type 2 diabetes. This study was undertaken alongside a clinical trial that found that remission of type 2 diabetes was five times greater in surgically treated patients, relative to those receiving conventional therapies, she said.

“For this patient group bariatric surgery generates both cost savings and health benefits,” Keating said. “This provides the strongest rationale yet for implementation of this treatment on economic grounds.”

Treatment studies have shown that bariatric surgery, initially developed for the treatment of morbid obesity, can improve or normalize blood sugar levels, reduce or even eliminate the need for medication, and lower the risk of diabetes-related death.

The studies looked at whether the costs of the surgery—estimated at between $15,000 and $24,000 in the United States—are justified by its effectiveness and its potential to save future health care treatment for obesity-related diseases such as type 2 diabetes.

To perform her analysis, Keating examined 16 published studies that looked at the cost-effectiveness of bariatric surgery, including gastric bypass and gastric banding. Ten of those studies examined the procedures in severely obese patients (those whose body mass index, or BMI, is greater than 35) who did not have type 2 diabetes and six looked at patients with type 2 diabetes whose BMI was 30 to 40 (moderately to severely obese).

Keating’s review found that bariatric surgery was very cost effective in both populations she studied (patients without diabetes and a BMI over 35, and patients with diabetes and a BMI 30 to 40), but that it was twice as cost effective in the latter category, the patients with type 2 diabetes.

“This is likely because patients with diabetes have greater ill heath and therefore more benefits can be achieved through surgery in terms of quality of life, life expectancy and prevention of future health care costs,” she said. “Without treatment, patients with type 2 diabetes would endure lifelong disease and escalating health care costs.”