Recent research has revealed that the long-term cost-effectiveness of newer weight loss medications significantly improves when these treatments are combined with bariatric surgery. This insight was shared during the American College of Surgeons (ACS) Clinical Congress 2024 held in San Francisco, California. A second study presented at the same congress highlighted that glucagon-like peptide-1 receptor agonists (GLP-1 RA), a novel class of weight loss drugs, can be safely used prior to bariatric surgery as a strategy for treating obesity.
Initially developed for managing Type 2 diabetes, the medications liraglutide (marketed as Saxenda) and semaglutide (known as Wegovy) have gained approval from the U.S. Food and Drug Administration (FDA) for weight loss in patients categorized as overweight or obese, particularly those with associated health conditions. These drugs function by imitating hormones that reduce appetite and enhance feelings of fullness.
Dr. Joseph Sanchez, a general surgery resident at Northwestern Medicine in Chicago and the lead author of the first study, explained that continuous use of GLP-1 RA is essential for sustaining weight loss. “GLP-1 RA are lifelong medications for obesity management, often not covered by insurance, and can impose monthly costs between $800 and $1,200. However, our understanding of how these drugs compare in cost-effectiveness to traditional obesity management options, like bariatric surgery, was limited,” he noted.
The study’s senior investigator, Dr. Anne Stey, an assistant professor of surgery at Northwestern University Feinberg School of Medicine, underscored the significance of these findings. “As the health benefits of GLP-1 RA become increasingly evident, insurance providers will need to evaluate whether to cover these medications and under what conditions. It’s crucial to assess the cost-effectiveness of different obesity management options to expand access to these treatments,” Dr. Stey stated.
Cost-Effectiveness Analysis
Dr. Sanchez and his research team conducted a comprehensive cost-effectiveness analysis comparing GLP-1 RA therapy alone, bariatric surgery alone (specifically gastric bypass or sleeve gastrectomy), and the combination of both approaches for managing obesity and preventing weight regain.
The researchers modeled the costs of these treatments over a projected lifespan of up to 50 years, drawing on data from various clinical trials across the U.S. They deemed a treatment cost-effective if it fell below $100,000 per quality-adjusted life year (QALY), a metric representing one healthy year of life gained from a medical intervention.
Findings indicated that while bariatric surgery costs ranged from $17,400 to $22,850, the annual expenses for GLP-1 RA therapy were between $9,360 and $16,200. When comparing the two, bariatric surgery was found to yield approximately two additional QALYs and save patients over $9,000 for each year of quality life gained. Furthermore, the combination of GLP-1 RA with bariatric surgery would provide an additional five QALYs while saving more than $7,200 per QALY compared to surgery alone.
“Opting for bariatric surgery is ultimately more cost-effective in the long term than relying on continuous medication,” Dr. Sanchez emphasized. “These medications are particularly valuable for addressing weight regain following surgery.”
However, he cautioned that these conclusions might shift if the costs of these medications decline significantly or if alternative, more affordable weight loss treatments become available—specifically, a price reduction of nearly 75% would be necessary for a reevaluation.
GLP-1 RA Utilization Prior to Surgery
In a related study from Indiana University (IU) School of Medicine, researchers observed a notable increase in the prescription of GLP-1 RA prior to bariatric surgery, rising from 8% in 2018 to 24% in recent years. Some experts propose utilizing these medications before surgery to facilitate weight loss in patients with a body mass index (BMI) exceeding 50, which complicates surgical procedures.
Dr. Tarik Yuce, the senior investigator of the IU study, remarked, “Reducing weight can potentially simplify and enhance the safety of the surgical process, opening up exciting possibilities for these medications.”
The study led by Dr. Qais AbuHasan, an IU School of Medicine research fellow, aimed to assess the safety and efficacy of GLP-1 RA usage in patients before undergoing bariatric surgery. Analyzing data from 2,169 patients treated at three IU-affiliated hospitals from 2018 to 2023, the researchers evaluated outcomes such as 30-day hospital readmissions, emergency department visits, and surgical complications.
Dr. AbuHasan reported no significant differences in short-term outcomes between patients who received GLP-1 RA preoperatively (293 patients) and those who did not (1,876 patients). Both groups exhibited comparable weight loss results one year after surgery, with those on GLP-1 RA losing a median of 25.5% of their total body weight, compared to 27.3% for those not on the medication.
“It appears that using GLP-1 RA in the preoperative phase may be safe,” he concluded, emphasizing the need for further research to explore how dosage and treatment duration may influence outcomes.
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