Newer weight loss drugs are cost effective in the long term only when combined with bariatric weight loss surgery, according to a study presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California.
Further, a second study presented at the meeting found that this increasingly popular class of weight loss drugs, called glucagon-like peptide-1 receptor agonists, or GLP-1 RA, appears safe and may be a novel approach to treating obesity when used before bariatric surgery.
Dr. Joseph Sanchez and colleagues performed a cost-effectiveness analysis of GLP-1 RA therapy alone and bariatric surgery alone — either gastric bypass or sleeve gastrectomy. They also studied the cost effectiveness of bariatric surgery in conjunction with treatment with GLP-1 RA to prevent weight regain.
The investigators predicted the costs of each of these treatments until death (up to 50 years) for thousands of patients from different clinical trial findings around the United States. The researchers considered a treatment to be cost effective if the total cost was less than $100,000 per quality-adjusted life year (QALY). A QALY is one adequately healthy year of life a patient could gain from treatment.
At $17,400 to $22,850, the estimated cost of bariatric surgery exceeded the average yearly cost of $9,360 to $16,200 for GLP-1 RA, the researchers found. However, compared with these medications alone, bariatric surgery added approximately two QALYs and would save a patient more than $9,000 to earn a year of quality life. GLP-1 RA combined with bariatric surgery would save more than $7,200 per QALY versus surgery alone and added more than five QALYs.
A study from Indiana University (IU) School of Medicine in Indianapolis found that the use of GLP-1 RA in the year before bariatric surgery has increased more than threefold since 2018 — from 8% to 24%.
Some researchers have proposed using GLP-1 RA medications before bariatric surgery to help lower the weight of patients with a body mass index (BMI) greater than 50, which can make the operation more complex, said Tarik Yuce, MD, MS, the study’s senior investigator, an ACS Associate Fellow, and an assistant professor of surgery at IU School of Medicine. A BMI of 40 or greater is considered severe obesity.
The research team studied outcomes for 2,169 patients who underwent bariatric surgery at three IU-affiliated hospitals from 2018 through 2023. Outcomes evaluated included differences in 30-day hospital readmissions, emergency department visits, and complications for patients who preoperatively used GLP-1 RA (293 patients) and patients who did not (1,876 patients).
Dr. Qais AbuHasan reported no statistically significant differences between treatment groups in these short-term outcomes or in the percentage of total weight loss one year after surgery. Patients who used GLP-1 RA preoperatively lost a median of 25.5% of their total weight one year after the operation, and patients who did not use these medications lost 27.3% of total weight.
