Bariatric Surgery proves more cost-effective than standalone GLP-1 RA therapy

Published on November 19 , 2024 | 5 Minutes to Read

What are GLP-1 agonists?

GLP-1 agonists, or Glucagon-Like Peptide-1 receptor agonists, are medications primarily prescribed for managing type 2 diabetes (HbA1c), certain cardiovascular risks in people with type 2 diabetes and, more recently, obesity. They work by mimicking GLP-1, a natural hormone in the body that plays a crucial role in regulating blood sugar levels and controlling appetite.

FDA-approved GLP-1 receptor agonists for glycemic control include:

Dulaglutide (subcutaneous-SC)
Exenatide injectable solution subcutaneous
Exenatide injectable suspension SC
Liraglutide SC
Liraglutide/insulin degludec
Lixisenatide/insulin glargine
Semaglutide (oral, SC)
Tirzepatide (dual GIP/GLP-1 receptor agonist)

FDA-approved GLP-1 agonists for weight loss include:

Semaglutide SC
Liraglutide SC

GLP-1 agonists are typically administered as injections (daily or weekly, depending on the medication), though some oral options are now available.

How do they work:

Boost insulin production: GLP-1 agonists prompt the pancreas to release insulin in response to food, aiding in lowering blood sugar levels.
Lowering glucagon levels: These medications decrease glucagon, a hormone that raises blood sugar, reducing excess glucose production by the liver.
Delaying stomach emptying: They slow down the digestive process, creating a sense of fullness and preventing rapid spikes in blood sugar after meals.
Curbing hunger: By influencing brain centers that regulate appetite, GLP-1 agonists help suppress hunger and support weight loss efforts.

However, a recent study presented at the 2024 American College of Surgeons (ACS) Clinical Congress in San Francisco highlighted that Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are financially viable as a long-term treatment option only when combined with bariatric surgery. The research, titled “Comparative cost-effectiveness analysis of bariatric surgery and GLP-1 receptor agonists for the management of obesity,” emphasized the synergy between these medications and surgical intervention for managing obesity.

Another study discussed at the same event, “The impact of preoperative glucagon-like peptide-1 receptor agonists (GLP1RA) utilization on bariatric surgery outcomes,” suggested that using GLP-1 RAs before surgery is a safe and promising strategy for weight loss, offering a potentially innovative method for improving obesity management outcomes.

Lifelong Medication vs. Surgery

Dr. Joseph Sanchez, the study’s lead author and a general surgery resident at Northwestern Medicine, emphasized that GLP-1 RAs often require lifelong use to maintain weight loss, posing a significant financial burden for many.

“These medications can cost $800 to $1,200 (USD) per month out-of-pocket, as they are not always covered by insurance,” Sanchez explained. “We wanted to evaluate how they compare with bariatric surgery, the gold standard for obesity treatment, in terms of cost-effectiveness.”

Dr. Anne Stey, the senior investigator and an assistant professor of surgery at Northwestern University, highlighted the importance of this research:
“As evidence grows regarding the health benefits of GLP-1 RAs, insurance providers must assess their coverage policies. Understanding the cost-effectiveness of different obesity treatments is key to ensuring broad accessibility.”

The Findings

Researchers conducted a detailed cost-effectiveness analysis of three approaches: GLP-1 RA therapy alone, bariatric surgery alone, and a combination of both to prevent weight regain. Costs were projected over a lifetime (up to 50 years), using a benchmark of $100,000 (USD) per quality-adjusted life year (QALY) to define cost-effectiveness.

Bariatric Surgery: The upfront cost ranged from $17,400 to $22,850, (USD) compared to the annual cost of GLP-1 RAs, estimated at $9,360 to $16,200 (USD). However, surgery provided an additional two QALYs and saved over $9,000 per year of quality life compared to medications alone.
Combination Therapy: Adding GLP-1 RAs to bariatric surgery saved over $7,200(USD) per QALY and added five additional QALYs versus surgery alone.

Dr. Sanchez noted, “From a cost-effectiveness standpoint, bariatric surgery remains the superior option for long-term obesity management. However, GLP-1 RAs can play a critical role in addressing post-surgical weight regain.”

The cost landscape could shift if GLP-1 RA prices decrease by approximately 75% or if more affordable alternatives emerge.

Preoperative Use of GLP-1 RAs: A Safer Approach?

A separate study conducted by Indiana University (IU) School of Medicine explored the potential benefits of using GLP-1 RAs before bariatric surgery. The research examined outcomes for 2,169 patients undergoing bariatric procedures between 2018 and 2023, with 293 of them receiving GLP-1 RAs in the year prior.

Dr. Tarik Yuce, the senior investigator and assistant professor of surgery at IU, suggested that preoperative use of these medications might simplify surgery for patients with a BMI over 50, making procedures safer and more manageable.

The study revealed no significant differences in short-term outcomes, such as 30-day hospital readmissions or complications, between patients who used GLP-1 RAs and those who did not. Both groups experienced similar weight loss one-year post-surgery, with median losses of 25.5% and 27.3%, respectively.

Dr. Qais AbuHasan, the study’s lead author, concluded, “Preoperative GLP-1 RA use appears to be safe, but further research is needed to understand whether factors like dosage or treatment duration affect outcomes.”

Looking Ahead

These findings highlight the growing role of GLP-1 RAs in obesity management, whether as a standalone option, in combination with bariatric surgery, or as a preoperative strategy. With advancements in medications and evolving cost dynamics, the future of obesity treatment continues to unfold.

References

https://www.bariatricnews.net/post/bariatric-surgery-found-to-be-more-cost-effective-than-glp-1-ras-alone

https://www.ncbi.nlm.nih.gov/books/NBK572151/