One of the downsides of surgery was the cost, but a new study found that the expense of taking weekly injections of popular antiobesity medications liraglutide (Saxenda) or semaglutide (Wegovy) exceeds that of metabolic and bariatric surgery in less than a year.
The analysis, published in the journal Surgical Endoscopy, was conducted by researchers from University of South Florida Health Morsani College of Medicine in Tampa, Florida. The study team compared the cumulative cost of pharmacotherapy with GLP-1 agonists with one-time surgical procedures—sleeve gastrectomy and Rou-en-Y gastric bypass.
“Bariatric surgery offers a more permanent and rapid resolution to obesity and metabolic syndrome, with cost-saving benefits in the long-term,” the authors wrote. “Bariatric surgery 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.”
The study compared average 2023 national retail prices for GLP-1s with surgical cost estimates from 2015, adjusted for inflation. The cumulative medication cost over time was calculated and compared to the flat cost of each surgery to come up with “break-even points” when medication costs equal surgery costs.
“The findings revealed a crucial insight, for some GLP-1s 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,” the authors noted. “Even the most affordable option, Byetta, becomes costlier than surgery after around 1.5 years.”
The researchers suggested that their findings highlight the importance of looking beyond the initial financial investment when considering cost-effectiveness. “Additionally, while not directly assessed, this study acknowledges that GLP-1s take time to reach full effectiveness, potentially delaying weight loss while accumulating costs,” the researchers added. “Concerns also exist about weight regain after discontinuing the medication.”
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 comorbidities “…and the reality of patient preference providing subjective value to either modality. Overall, the study offers insights into the financial trade-offs between GLP-1s and bariatric surgery,” the authors wrote.
“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,” stated Ann M. Rogers, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS), adding, “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 United States, which represents only about 1% of those who meet eligibility requirements based on BMI.
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