Cost-Effectiveness of Bariatric Surgery: Addressing Severe Obesity and Comorbidities With RYGB and SG

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) is highly effective in addressing severe obesity and associated comorbidities such as diabetes and hypertension. While it has no cost-saving opportunities in the short to medium term due to complications and acute care, it is still considered cost-effective and a recommended treatment option for severe obesity. However, there's limited research comparing the impact of RYGB and SG on health care use and costs, according to a study published in the JAMA Network Open.

This study aimed to investigate changes in ambulatory health care use and costs over four years following RYGB and SG. The hypothesis was that RYGB would significantly reduce medication costs, office visits, and overall ambulatory spending due to its superior clinical outcomes.

The study analyzed data from a large national commercial claims database from 2006 to 2017. Patients who underwent RYGB and SG between 2008 and 2016 were included, with continuous enrollment for at least 24 months before and 12 months after the procedure. Researchers conducted difference-in-differences (DiD) analyses to compare pre and postsurgical changes between the two procedures.

Primary cohorts included 3049 SG patients and 3251 RYGB patients, well balanced on measured baseline characteristics. The study found no statistically significant differences in total annual ambulatory cost changes between SG and RYGB during the four-year follow-up period. Prescription costs decreased after surgery for both procedures, with significant differences emerging in the fourth postoperative year, where SG patients had higher prescription costs than RYGB patients. Patients undergoing SG also had more cardiometabolic prescription fills than RYGB patients.

Changes in office visit costs did not differ between the 2 procedures through the 4 postoperative years. Specialist visits decreased slightly for SG patients compared to RYGB patients in the first and third postoperative years.

It's worth noting that the study had limitations, including cohort attrition and an inability to identify patient deaths. Despite RYGB's superior clinical outcomes, there were no observed lower total ambulatory care costs up to 4 years after surgery, indicating that SG may be a more favorable option regarding health care spending and early complication rates. It is an analysis worth revisiting in the near future.

"Remaining questions include whether, with longer-term follow-up, ambulatory spending could be lower for RYGB based on a greater or more durable benefit for cardiometabolic disease," said researchers.

Reference

Lewis KH, Argetsinger S, Arterburn DE, et al. Comparison of ambulatory health care costs and use associated with Roux-en-Y gastric bypass vs sleeve gastrectomy. JAMA Network Open. 2022;5(5):e229661. doi:10.1001/jamanetworkopen.2022.9661