GLP-1RA treatment costs $109 more monthly than bariatric surgery for obesity, diabetes.
Background
The global rise in obesity and type 2 diabetes (T2D) presents significant clinical and economic burdens. Both bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are highly effective interventions for these conditions, offering substantial improvements in weight loss and glycemic control. However, a comprehensive understanding of their long-term impact on healthcare utilization costs, beyond the initial intervention, has remained a critical gap. This economic comparison is vital for healthcare policy, patient counseling, and resource allocation in managing these chronic diseases.
Study Design
This observational, retrospective cohort study analyzed electronic medical records from Clalit Health Services in Israel. Researchers identified 5442 adults (aged ≥24 years) with obesity (body mass index [BMI] ≥30) and diabetes who either initiated GLP-1RA therapy or underwent their first BMS between January 1, 2010, and December 31, 2022. Propensity score matching created 2721 matched pairs. Patients were followed for up to 12.5 years (mean 6.5 years) through December 31, 2023. The primary endpoint was health care utilization costs incurred by the health system, excluding the index intervention costs, estimated using a difference-in-differences approach and multivariable linear regression.
Results
The matched cohort comprised 5442 adults (mean age 51 years; 59.6% women; mean BMI 40.5). Mean monthly follow-up costs were significantly higher for patients treated with GLP-1RAs ($415.3) compared to those who underwent BMS ($304.9). The adjusted difference-in-differences analysis revealed that GLP-1RA treatment was associated with $109.0 higher monthly costs per patient (SE = $17.0; P < .001).
Key Findings
- GLP-1RA treatment incurred $109.0 higher monthly healthcare costs per patient compared to bariatric metabolic surgery.
- Mean monthly follow-up costs were $415.3 for GLP-1RA users vs. $304.9 for BMS patients.
- Higher GLP-1RA costs were primarily driven by hospitalization costs ($43.9; P = .001) and non-GLP-1 medication costs ($52.5; P < .001).
- The study followed 2721 matched pairs for up to 12.5 years, providing long-term cost comparison data.
Why It Matters
This study provides crucial long-term economic data for patients and healthcare systems managing obesity and type 2 diabetes. The finding that GLP-1RA therapy incurs significantly higher monthly healthcare utilization costs than bariatric metabolic surgery over the long term, primarily due to ongoing medication and hospitalization expenses, has substantial implications. For clinicians and policymakers, this suggests that while GLP-1RAs are effective, the one-time investment in BMS may offer a more cost-effective long-term solution for eligible patients. This data should inform shared decision-making, potentially shifting the conversation towards BMS as a more economically sustainable option for some, despite its surgical nature. It highlights the need to consider the total cost of care, not just drug acquisition, when evaluating treatment strategies.
glp-1ra
bariatric-surgery
obesity
type-2-diabetes
healthcare-costs
economic-analysis