Obese patients with type 2 diabetes and especially those diagnosed with recent diabetes should be prioritised for weight loss surgery over those patients with a higher BMI and diabetes. When taking healthcare costs into consideration many patients see a reversal of diabetes after surgery which means fewer expensive diabetes medication or treatment for diabetic related complications in future.
These are claims made by Swedish and Australian researchers in their paper, “Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects Study”, published in The Lancet Diabetes & Endocrinology.
Current Situation
Most healthcare systems prioritise access to weight loss surgery based on a person’s BMI which generally means that high BMI patients get priority. Patients with lower BMI’s and obesity-related health problems like type 2 diabetes should also be considered for surgery but guidelines around the world differ greatly. It has been recommended that the status of the patient’s diabetes rather than BMI alone be used to select patients to receive weight loss surgery. The long-term effect of weight loss surgery relative to conventional therapy on the costs in obese patients according to their diabetes status has not been assessed using real-world data. Therefore, the authors of this paper wanted to look at the healthcare costs over 15 years for this group of patients treated medically and surgically.
Method
The study included 2,010 patients who had weight loss surgery and were matched with a control group of 2,037 patients who were treated medically. The patients came from 25 surgical departments and 480 primary health-care centres. The researchers retrieved the prescription drug costs for the patients via questionnaires and the nationwide prescribed drug register. They followed up the sample linked to register data for up to 15 years.
Outcome
The authors state that previous studies have assessed the entire eligible obese population and have likely underestimated the cost benefits of weight loss surgery for patients with type 2 diabetes while overestimating them for patients without type 2 diabetes. This study demonstrated that for obese patients with type 2 diabetes, the upfront costs of weight loss surgery seems to be largely offset by prevention of future health-care and drug use. 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 (eg ÂŁ20 000 per quality-adjusted life year in the UK) is the economic benchmark adopted by payers when new interventions are assessed. Weight loss surgery should be held to the same economic standards as other medical interventions.
In conclusion weight loss surgery should be an option for patients with type 2 diabetes regardless of the BMI.
Reference: DOI: http://dx.doi.org/10.1016/S2213-8587(15)00290-9
Authors: C. Keating, M.Neovius, K. Sjoholm, M. Peltonen, K. Narbro, J. Eriksson, L. Sjostrom & L. Carlsson