For diabetics, obesity surgery should be prioritized

A new study has suggested that patients with type 2 diabetes should be prioritized for obesity surgery.

The study suggests that, when considering overall costs of healthcare, obese patients with type 2 diabetes, especially those with recent disease onset, should be prioritised for obesity surgery over those without type 2 diabetes, since many patients see a reversal of diabetes after surgery and thus need fewer expensive diabetes medications or treatment for complications in future.

Compared with patients treated conventionally, total healthcare costs (accounting for costs of 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 22,390dollars per patient) or who had prediabetes (26,292 dollars), but not in patients with diabetes, 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. Remission of diabetes also means that diabetes complications are lessened, further reducing future healthcare costs.

To their knowledge, this is the first prospectively controlled study to assess long-term healthcare costs in obesity surgery patients according to their preoperative diabetes status versus matched controls, say the authors.

Because previous studies have assessed the entire eligible obese population, they have likely underestimated the cost benefits of obesity surgery for those with type 2 diabetes, while overestimating them for patients without type 2 diabetes.

They concluded that they showed 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.

They further added that this finding of cost neutrality is seldom noted for health-care interventions, nor is it a requirement of funding in most settings. Usually, buying of health benefits at an acceptable cost is the economic benchmark adopted by payers when new interventions are assessed. Bariatric surgery should be held to the same economic standards as other medical interventions.

The study is published in The Lancet Diabetes & Endocrinology.