Medication cost for treatment of metabolic dysregulation decreases following adolescent bariatric surgery.

BACKGROUND

The burden of obesity-related metabolic dysfunction in adolescents is skyrocketing; the purpose of this study is to understand the impact of adolescent bariatric surgery on the utilization and cost of medications for treatment of metabolic dysregulation.

METHODS

Using the MarketScan database of commercial health insurance claims from 2011-2019, bariatric surgery patients ages 14-18 (n = 992) were assessed for patterns of medication utilization pre-surgery (beginning of MarketScan enrollment to 6 months before surgery) and post-surgery (> 12 months after surgery). We examined the cost and rate of prescription fills for diabetes, cardiovascular, and dyslipidemia medications. We calculated standardized utilization rates and ran generalized estimating equations for utilization and cost of each medication with Poisson distribution to test for differences at the various time intervals. We also compared utilization and cost for the surgical patients two three control groups, stratified based on body mass index.

RESULTS

Utilization of diabetes and dyslipidemia medications showed a significant decrease in the incidence rate ratio (95% confidence interval) for the post-surgery period relative to the pre-surgery period (0.428 (0.223-0.82) p = 0.01; 0.194 (0.056-0.667) p < 0.01). The total annual cost for the entire cohort of bariatric surgery patients (95% confidence interval) also decreased after surgery with dyslipidemia medications decreasing by $8,666.11 ($1011.84-$16,308.48), cardiovascular medications decreasing by $33,890.68 ($14,403.84-$53,389.44) and diabetes medications decreasing by $45,949.44 ($3,083.14-$94,993.92).

CONCLUSION

Following adolescent bariatric surgery, there is a decrease in utilization of diabetes and dyslipidemia medications. There was decreased cost for diabetes, dyslipidemia, and cardiovascular medications. These results suggest that performing bariatric surgery during late adolescence is associated with overall improvements in metabolic health.