Medical Research: What is the background for this study? What are the main findings?
Dr. Neovius: Long-term real world data on economic effects of bariatric surgery versus nonsurgical treatment are scarce. We have previously looked at long-term drug costs, inpatient and outpatient care in the overall bariatric surgery population (Neovius, Narbro et al, JAMA 2012). However, overall findings may mask important subgroup variations.
Based on data from the Swedish Obese Subjects (SOS) study, we documented large drug cost savings over 15 years after bariatric surgery versus non-surgically treated controls in patients who had diabetes and prediabetes before intervention. No savings were seen in patients who were euglycemic at baseline.
In terms of overall healthcare costs, we saw cost-neutrality versus non-surgically treated patients for the diabetes group, while costs were higher for both patients with normal blood glucose and those with prediabetes (due to the initial high cost of surgery and inpatient care).
For the subgroup of patients with diabetes, we also found that patients with recent diabetes onset had more favorable economic outcomes than patients with established diabetes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Neovius: These findings reinforce previous clinical findings of better health outcomes in patients with prediabetes and diabetes, supporting the notion to prioritize such patients for bariatric surgery rather than using body mass index for prioritization. We show that this makes not only sense from a health outcome perspective, but also economically.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Neovius: We looked only at healthcare costs in this study, but not at potential differential effects also on work loss by preoperative glucose status. Furthermore, long-term data means that the surgical procedures used in the study are different from the ones used today. Replication of the findings with current data is important.
Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study
Published online: September 16, 2015
Catherine Keating, Martin Neovius, Kajsa Sjöholm, Markku Peltonen, Kristina Narbro, Jonas K Eriksson, Lars Sjöström, Lena M S Carlsson
The Lancet Diabetes & Endocrinology
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