Bariatric surgery is expensive but improves co-morbidity: 5-year assessment of patients with obesity and type 2 diabetes

Abstract

Background Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here. Methods Population-based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006–2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co-morbidity Index (CCI) scores and co-morbidity rates were measured to compare changes in co-morbidities between surgically treated and control groups over 5 years. One-to-five propensity score matching was applied. Results Overall, 401 eligible surgical patients were matched with 1894 non-surgical patients. Direct medical costs were much higher for surgical than non-surgical patients in the index year (€36 752 and €5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5-year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5-year period, surgical patients had shorter length of stay in hospitals than non-surgical patients in year 2-5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose-lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose-lowering medications in year 2 (€973 versus €1395; P = 0.012). Conclusion Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co-morbidity profile, and reduced length of hospitalization.

Comparison of pre-and postoperative medication costs in patients who underwent bariatric surgery – a nationwide data analysis

“…Likewise, in the study of Swedish Obese Subjects (SOS) ( 14 ) the costs of medication used in diabetes treatment decreased significantly after bariatric surgery. In turn, Wu et al ( 29 ) demonstrated that for patients who had undergone bariatric surgery, the costs of diabetes drugs illustrate a U-shape curve. The costs of medication in patients after operation were shown to drop 2 years after surgery (€1752 in year 1 and €973 in year 2) and rise by year 5 (to €1836).…”

Recommendations for eligibility criteria concerning bariatric and metabolic surgical and endoscopic procedures for obese Hong Kong adults 2024: Hong Kong Society for Metabolic and Bariatric Surgery Position Statement

“…Hong Kong's first bariatric surgery programme was established in 2002 at Prince of Wales Hospital, affiliated with The Chinese University of Hong Kong. 22 Encouraged by the success and safety of the early Prince of Wales Hospital obesity surgery service, 23 increasing numbers of public and private hospitals have begun to provide bariatric surgical interventions to obese patients in Hong Kong (Table ).…”