Health Expenditures Decline After Bariatric Surgery for Patients With Type 2 Diabetes.

OBJECTIVE: Bariatric surgery lowers the risk of developing microvascular and macrovascular complications of type 2 diabetes, but it is unclear whether it also lowers long-term health expenditures in this population. RESEARCH DESIGN AND METHODS: In a retrospective cohort study of 6,690 patients with obesity and type 2 diabetes who underwent bariatric surgery in 2012-2019 and 19,122 matched nonsurgical patients, we compared total, outpatient, inpatient, and medication expenditures 3 years presurgery and 5.5 years postsurgery, using generalized estimating equations. Expenditures were estimated in 6-month intervals. RESULTS: Surgical and nonsurgical cohorts were well-matched, with 73% female, average BMI 44 kg/m2, mean age 50 years, and 32% on insulin. Estimated total expenditures were similar between surgical and nonsurgical patients up to 1 year presurgery. Total expenditures were significantly lower for surgical patients starting 1 year postsurgery and up to 5.5 years postsurgery compared with control patients ($566 lower per 6-month interval at 5.5 years; 95% CI -$807, -$316). Expenditure differences were largely attributable to a 56% drop in medication expenditures for surgical patients, from $2,204 in the 6 months presurgery to $969 per 6-month interval at 5.5 years postsurgery. Surgical patients had a higher probability of inpatient admission throughout the postsurgical period (4.0-6.5% vs. 2.4-3.1% per 6-month interval). CONCLUSIONS: Patients with type 2 diabetes undergoing bariatric surgery have significantly lower total postsurgical expenditures than matched control patients, primarily because of substantial reductions in pharmacy expenditures. The long-term cost savings associated with bariatric surgery are likely to increase further, given the rapidly escalating costs of diabetes pharmacotherapy.

Duke Scholars

Author Valerie A. Smith Population Health Sciences

Author Caroline Sloan Medicine, General Internal Medicine

Author Matthew Leonard Maciejewski Population Health Sciences