The cost of taking weekly injections of popular obesity management medications liraglutide (Saxenda) or semaglutide (Wegovy) exceeds that of metabolic and bariatric surgery (BMS) in less than a year, according to a recent analysis by researchers from USF Health Morsani College of Medicine in Tampa, FL.
"Bariatric surgery offers a more permanent and rapid resolution to obesity and metabolic syndrome, with cost-saving benefits in the long-term," the researchers write. "Bariatric has consistently demonstrated a significant reduction in the use and cost of medications post-bariatric surgery, a decrease in clinic and emergency room visits, and a decreased all-cause mortality, which contributes to a significant cost-saving."
They compared average 2023 national retail prices for GLP-1s to surgical cost estimates of onetime surgical procedures (sleeve gastrectomy and Rou-en-Y gastric bypass), from 2015 adjusted for inflation, providing important new insights into cost considerations surrounding surgical and drug treatment of obesity.
By plotting the cumulative medication cost over time against the flat cost of each surgery, thus calculating "break-even points" (when medication costs equal surgery costs). The findings revealed a crucial insight, for some GLP-1 s like Saxenda and Wegovy, the high cost of ongoing use surpasses the cost of RYGB in less than a year and sleeve gastrectomy within nine months. Even the most affordable option, exenatide (brand name Byetta), becomes costlier than surgery after around 1.5 years.
According to the researchers, this highlights the importance of looking beyond the initial financial investment when considering cost-effectiveness. Additionally, while not directly assessed, GLP-1s take time to reach full effectiveness, potentially delaying weight loss while accumulating costs. Concerns also exist about weight regain after discontinuing the medication.
The researchers acknowledge that this study is limited by the real-world variation for individual treatment costs (e.g. insurance), a limited evaluation of long-term costs associated with either treatment modality and their co-morbidities, and the reality of patient preference providing subjective value to either modality. Overall, the study offers insights into the financial trade-offs between GLP-1 s and bariatric surgery.
"Studies consistently show the efficacy of metabolic surgery in achieving long-term diabetes remission and substantial weight loss, far surpassing results achieved with medical management or diets and exercise alone,” added Dr Ann M Rogers, President, American Society for Metabolic and Bariatric Surgery. “This not only results in better health, but in significant cost savings too - yet another reason for patients to consider surgery and insurers to expand access to the gold standard of obesity treatment."
The ASMBS reports that in 2022 nearly 280,000 metabolic and bariatric procedures were performed in the U.S., which represents only about 1% of those who meet eligibility requirements based on BMI. According to the U.S. Centers for Disease Control and Prevention (CDC), the U.S. obesity rate is about 40%. Severe obesity affects about 1 in 10.
The findings were reported in the paper, ‘A cost comparison of GLP-1 receptor agonists and bariatric surgery: what is the break even point?’ published in Surgical Endoscopy. To access this paper, please click here (log-in maybe required)
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