Bariatric surgery more effective, affordable than GLP-1RAs for severe obesity

For individuals with class II and III obesity, metabolic bariatric surgery appears to result in durable weight loss at lower ongoing costs when compared with glucagon-like peptide-1 receptor agonists (GLP-1RAs), according to a study.

Researchers used data from the Highmark Health insurance claims database and the Allegheny Health Network electronic medical record in the US. They identified patients with class II or III obesity who either underwent metabolic bariatric surgery or were treated with GLP-1RAs.

A total of 30,458 propensity-score matched patients (mean age 50 years, 66.1 percent female) were included in the analysis. Of these, 14,101 underwent metabolic bariatric surgery (mean follow-up 34 months) and 16,357 received GLP-1RAs (mean follow-up 32 months).

The mean total costs over 2 years were significantly smaller with metabolic bariatric surgery, at USD 51,794 as opposed to USD 63,483 with GLP-1RAs (p<0.001). This difference was driven by higher sustained pharmacy costs throughout the second year of follow-up in the GLP-1 RA group.

Weight loss data from a subset of 257 patients using GLP-1 RAs and 1,291 patients who underwent metabolic bariatric surgery showed that surgery led to a 28.3-percent reduction in total weight, more than double the 10.3-percent lost with GLP-1RAs (p<0.001).

More studies are warranted to determine whether there are patient subgroups that would benefit from an earlier referral to surgery.