A retrospective study explores how surgical and pharmacologic weight-loss strategies stack up in cost, effectiveness, and health outcomes.

Key takeaways:

  • The analysis drew from more than 30,000 real-world patient cases spanning 2018 to 2023.
  • Researchers linked insurance claims with electronic health records to assess both cost and clinical outcomes longitudinally.
  • GLP-1 treatment required sustained adherence, which contributed significantly to cumulative costs.
  • The findings underscore the importance of individualized treatment planning based on patient BMI, comorbidities, and long-term goals.
  • Authors note that understanding economic sustainability is increasingly important as obesity rates and treatment demand grow.

For obese patients, bariatric surgery achieves greater weight loss at a lower ongoing cost compared to GLP-1s, according to a new study authored by researchers at integrated payor/provider Highmark Health.

This retrospective study, which examined data from Highmark Health Plan insurance claims and Allegheny Health Network medical records, included 30,458 patients treated between 2018 and 2023. The research compared the health care costs and clinical outcomes of patients who underwent metabolic bariatric surgery, such as a sleeve gastrectomy or gastric bypass, with those who received glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for obesity management.   

Key findings, published Sept 17 in JAMA Surgery, include: 

  • Cost Savings with Bariatric Surgery: Over two years, bariatric surgery resulted in approximately 18% lower costs compared to medications, mostly because of sustained high pharmacy costs associated with medication use. This translates to an average cost savings of nearly $12,000 per patient.   
  • Greater Weight Loss with Bariatric Surgery: In patients with a BMI of 40 or higher, bariatric surgery led to nearly three times as much weight loss compared to medications. On average, patients lost about 28% of their weight with surgery, compared to about 10% with medications.  
  • Reduced Healthcare Utilization with Bariatric Surgery: On average, patients who underwent bariatric surgery had 25% fewer inpatient stays and 38% fewer emergency room visits. Bariatric surgery was also associated with a lower incidence of obesity-related comorbidities, such as hyperlipidemia and sleep apnea, compared to medication use.   

“This real-world study provides evidence on the long-term effectiveness and cost-efficiency of bariatric surgery compared to weight management medication for severe obesity,” says paper first author Tyson S. Barrett, PhD, Highmark Health Research Institute, in a release. “Our findings highlight the potential for bariatric surgery to offer a more durable and economically sound solution for this patient population.”   

The study specifically looked at the costs and clinical side effects of surgery versus GLP-1s for managing class II and class III obesity, as well as weight loss outcomes for those with class III obesity. 

GLP-1s have shown promise for weight loss, but also require ongoing adherence, the cost of which compounds over time.  

“With projections indicating that 50% of the adult U.S. population will have obesity by 2030, it’s vital for physicians to have comprehensive data to inform their treatment decisions,” says paper coauthor George Eid, MD, chair of the AHN Bariatric and Metabolic Institute, in a release. “This study should serve as a data point to help physicians make individualized care choices, optimizing each patient’s weight management journey.”  

Highmark Health is a Pittsburgh-based health services organization that includes a multi-state insurance services division (Highmark Health Plan) and a 14-hospital care provider (AHN). 

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