Roux-en-Y gastric bypass and sleeve gastrectomy may be equally cost-effective among patients with type 2 diabetes

1. In this retrospective cohort study of patients with diabetes who received Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy, health expenditures decreased by around 30% every 6 months.

2. Health expenditures were overall similar between patients who received either of the two surgeries except in the 6 months immediately after surgery, when inpatient expenditures were higher for the RYGB group.

Evidence Rating Level: 2 (Good)

Study Rundown: In patients with type 2 diabetes (T2D), bariatric surgery can lead to weight loss and diabetes remission as well as reduce risk of vascular disease and death. Although simulations have shown that bariatric surgery may be cost-effective, they are based on estimates of long-term expenditures and have not yet been replicated using real-world data in a population with obesity and T2D. This study aimed to compare long-term health expenditures associated with Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) among this population. Total expenditures were not found to be significantly different between RYGB and SG from 3 years before surgery through 5.5 years after surgery, other than the 6 months immediately following surgery. This difference was primarily attributed to higher inpatient costs among those who underwent RYGB. On average, both groups saw a cost reduction of nearly one-third every 6 months. Outpatient expenditures did not significantly differ between the two surgeries; both groups saw an increase in cost as the surgery approached followed by a cost reduction post-surgery. Outpatient medication expenditures also did not significantly differ between the two groups and followed a similar trend to outpatient expenditures, decreasing by over half in the 5.5 years after surgery. The generalizability of this study was limited by its observational nature, its single-center design, a lack of data on confounding factors affecting health expenditure, and the lack of a non-surgical control group. Nevertheless, this study showed that RYGB and SG appear to be equally cost-effective over the long-term in patients with T2D.

Click to read the study in AIM

Relevant Reading: Cost-Effectiveness of Bariatric Surgery for Severely Obese Adults With Diabetes

In-Depth [retrospective cohort]: This study aimed to assess differences in long-term health expenditures between RYGB and SG in T2D patients. A total of 6690 participants were included, 3515 of whom had SG surgery and 3175 RYGB surgery. Total, inpatient, outpatient, and medication expenditures were calculated for patients from 3 years before surgery through 5.5 years after surgery; outpatient costs were calculated by multiplying the number of times each type of health care was used by the cost of that service, while inpatient costs were calculated from Medicare reimbursements. For both groups, total expenditures decreased by approximately 30% every 6 months; RYGB patients saw a decrease from $4039.06 (95% CI, $3770.88 to $4326.31) 3 years before to $2441.13 (95% CI, $2151.07 to $2770.30) 5.5 years after surgery, while SG expenditures decreased from $3918.37 (95% CI, $3658.75 to $4196.40) 3 years before to $2658.15 (95% CI, $2279.17 to $3100.16) 5.5 years after surgery. Notably, medication expenditures were similar between RYGB and SG; between 31 and 36 months before surgery, they ranged between $2200 and $2300 (difference, $32.38 [95% CI, -$244.20 to $312.50]), and they increased as surgery approached (difference between 7 and 12 months pre-surgery, $271.33 [95% CI, $28.54 to $511.80]). At 5.5 years after surgery, expenditures every 6 months had decreased by over 50% ($1012.51 [95% CI, $769.93 to $1331.51] for RYGB and $1016.79 [95% CI, $623.78 to $1657.40] for SG; difference, -$4 [95% CI, -$462 to $411]). Overall, this study showed that RYGB and SG both reduced health expenditures by a similar proportion, suggesting that the two surgeries may be similarly cost-effective.

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.