Division of Gastrointestinal Surgery, Tampa General Hospital, Horatio Street, Tampa, FL, 33609, USA.
Morsani College of Medicine, University of South Florida, Horatio Street, Tampa, FL, 33609, USA.
Surg Endosc. 2024 Nov;38(11):6560-6565. doi: 10.1007/s00464-024-11191-1. Epub 2024 Sep 16.
With the prevalence of obesity rising in the US, medical management is of increasing importance. Two popular options for the treatment of obesity are bariatric surgery (e.g. sleeve gastrectomy and Roux-en-Y gastric bypass) and the increasingly popular GLP-1 Receptor Agonists (GLP-1 s). This study examines the initial and long-term costs of GLP-1 s compared to bariatric surgery.
We compared average 2023 national retail prices for GLP-1 s to surgical cost estimates from 2015 adjusted for inflation. We then plotted the cumulative medication cost over time against the flat cost of each surgery, thus calculating "break-even points" (when medication costs equal surgery costs). The findings revealed a crucial insight, for some GLP-1 s 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. Even the most affordable option, Byetta, becomes costlier than surgery after around 1.5 years.
This highlights the importance of looking beyond the initial financial investment when considering cost-effectiveness. Additionally, while not directly assessed, this study acknowledges that GLP-1 s take time to reach full effectiveness, potentially delaying weight loss while accumulating costs. 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 co-morbidities, and the reality of patient preference providing subjective value to either modality. Overall, the study offers insights into the financial trade-offs between GLP-1 s and bariatric surgery.
随着美国肥胖症的流行率上升，医学管理变得越来越重要。肥胖症治疗的两种流行选择是减重手术（例如胃袖状切除术和 Roux-en-Y 胃旁路术）和越来越受欢迎的 GLP-1 受体激动剂（GLP-1s）。本研究比较了 GLP-1s 与减重手术的初始和长期成本。
我们比较了 2023 年 GLP-1s 的全国零售平均价格与经通胀调整后的 2015 年手术成本估算。然后，我们将随时间推移的累积药物成本与每种手术的固定成本进行对比，从而计算出“盈亏平衡点”（即药物成本等于手术成本的点）。研究结果揭示了一个关键的见解，对于某些 GLP-1s，如 Saxenda 和 Wegovy，持续使用的高昂成本在不到一年的时间内超过了 RYGB 的成本，在九个月内超过了胃袖状切除术的成本。即使是最便宜的选择 Byetta，在大约 1.5 年后也会变得比手术更昂贵。
这突显了在考虑成本效益时不仅要考虑初始财务投资的重要性。此外，虽然本研究没有直接评估，但它承认 GLP-1s 需要时间才能达到完全有效，这可能会在积累成本的同时延迟体重减轻。停药后体重反弹的问题也存在。
本研究受到个体治疗成本（例如保险）的实际变化、对两种治疗方式相关的长期成本及其合并症的有限评估以及患者对任何一种方式的偏好提供主观价值的现实的限制。总体而言，该研究提供了关于 GLP-1s 和减重手术之间财务权衡的见解。
