Identifying Barriers to Appropriate Use of Metabolic/Bariatric Surgery for Type 2 Diabetes Treatment: Policy Lab Results

Abstract

Despite increasing recognition of the efficacy, safety, and cost-effectiveness of bariatric/metabolic surgery in the treatment of type 2 diabetes, few patients who may be appropriate candidates and may benefit from this type of surgery avail themselves of this treatment option. To identify conceptual and practical barriers to appropriate use of surgical procedures, a Policy Lab was hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes on 29 September 2015. Twenty-six stakeholders participated in the Policy Lab, including academics, clinicians, policy-makers, industry leaders, and patient representatives. Participants were provided with a summary of available evidence about the cost-effectiveness of bariatric/metabolic surgery and the costs of increasing the use of bariatric/metabolic surgery, using U.K. and U.S. scenarios as examples of distinct health care systems. There was widespread agreement among this group of stakeholders that bariatric/metabolic surgery is a legitimate and cost-effective approach to the treatment of type 2 diabetes in obese patients. The following four building blocks were identified to facilitate policy changes: 1) communicating the scale of the costs and harms associated with rising prevalence of type 2 diabetes; 2) properly articulating the role of bariatric/metabolic surgery for certain population groups; 3) identifying new funding sources for bariatric/metabolic surgery; and 4) incorporating bariatric/metabolic surgery into the appropriate clinical pathways. Although more research is needed to identify specific clinical scenarios for the prioritization of bariatric/metabolic surgery, the case appears to be strong enough to engage relevant policy-makers and practitioners in a concerted discussion of how to better use metabolic surgical resources in conjunction with other interventions in good diabetes practice.

Reconciliation of Type 2 Diabetes Remission Rates in Studies of Roux-en-Y Gastric Bypass

“…Several authors have argued for changing the standard definitions for remission after metabolic surgery to allow the use of metformin (18,20,21). Metformin therapy is now considered a standard of care for the prevention of diabetes (22) and, thus, could be considered consistent with complete remission.…”

Delivery and impact of the NHS Health Check in the first 8 years: a systematic review

“…In the economic models, lower than anticipated coverage, for example, would merely reduce aggregated costs and aggregated health gains, without affecting the cost per QALY estimates. 7,40 Like other interventions (bariatric surgery, for instance) 41 and some pharmaceuticals (which might be subjected to a 'budget impact test'), 42,43 it seems NHS Health Checks may thus be simultaneously costeffective and unaffordable. 40 A pragmatic response might be to focus attention on targeting the distribution of NHS Health Checks towards those who would benefit most, and/or towards reducing health inequalities.…”

7. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2018

“…Retrospective analyses and modeling studies suggest that metabolic surgery may be cost-effective or even cost-saving for patients with type 2 diabetes, but the results are largely dependent on assumptions about the long-term effectiveness and safety of the procedures (73,74).…”