Economics and Policy in Bariatric Surgery

  • Thomas J. HoergerEmail author
Economics and Policy in Diabetes (AA Baig and N Laiteerapong, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Economics and Policy in Diabetes


Purpose of Review

The purpose of this review is to provide current synthesis of the evidence on the cost-effectiveness of bariatric surgery for persons with diabetes.

Recent Findings

Virtually, every study that has evaluated the cost-effectiveness of bariatric surgery for persons who are obese and have type 2 diabetes has concluded that surgery is cost-effective. A few studies outside the USA found that surgery is cost-saving. Currently, most but not all US insurers cover bariatric surgery in persons with type 2 diabetes and BMI ≥ 35 kg/m2.


Bariatric surgery is a cost-effective treatment for persons with type 2 diabetes and BMI ≥ 35 kg/m2. There is interest in extending surgery to persons with diabetes and lower BMI; the cost-effectiveness of treating these individuals with bariatric surgery should be explored. Despite the potential benefits, not all obese or overweight persons with diabetes will choose surgery.


Bariatric surgery Diabetes Cost-effectiveness 


Compliance with Ethical Standards

Conflicts of Interest

The author declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Oxford Living Dictionaries. Bariatric surgery: Oxford University Press; 2019. Accessed 31 Jan 2019.
  2. 2.
    Sugerman H. Bariatric surgery literature in nonbariatric surgical journals: July to December, 2006. Surg Obes Relat Dis. 2007;3(2):201–2. Scholar
  3. 3.
    American Society for Metabolic and Bariatric Surgery. Estimate of bariatric surgery numbers, 2011–2017. 2018. Accessed 26 Jan 2019.
  4. 4.
    •• Rubino F, Nathan DM, Eckel RH, Schauer PR, Alberti KG, Zimmet PZ, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77. Consensus statement from diabetes, surgical, and medical organizations recommending bariatric surgery treatment algorithm for persons with diabetes and making the case for the term “metabolic surgery. CrossRefGoogle Scholar
  5. 5.
    Brethauer SA, Kim J, el Chaar M, Papasavas P, Eisenberg D, Rogers A, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506. Scholar
  6. 6.
    •• O’Brien PE, Hindle A, Brennan L, Skinner S, Burton P, Smith A, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14. This publication is the most-complete, systematic review of long-term weight loss and health outcomes after bariatric surgery. CrossRefPubMedGoogle Scholar
  7. 7.
    Ikramuddin S, Korner J, Lee WJ, Bantle JP, Thomas AJ, Connett JE, et al. Durability of addition of roux-en-Y gastric bypass to lifestyle intervention and medical management in achieving primary treatment goals for uncontrolled type 2 diabetes in mild to moderate obesity: a randomized control trial. Diabetes Care. 2016;39(9):1510–8. Scholar
  8. 8.
    • O'Brien R, Johnson E, Haneuse S, Coleman KJ, O'Connor PJ, Fisher DP, et al. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study. Ann Intern Med. 2018;169(5):300–10. In a matched cohort study of persons with diabetes, bariatric surgery had a hazard ratio of 0.40 for microvascular events. CrossRefPubMedGoogle Scholar
  9. 9.
    • Fisher DP, Johnson E, Haneuse S, Arterburn D, Coleman KJ, O'Connor PJ, et al. Association between bariatric surgery and macrovascular disease outcomes in patients with type 2 diabetes and severe obesity. JAMA. 2018;320(15):1570–82. Bariatric surgery in patients with type 2 diabetes and severe obesity is associated with fewer cardiovascular events. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Doble B, Wordsworth S, Rogers CA, Welbourn R, Byrne J, Blazeby JM. Erratum to: What are the real procedural costs of bariatric surgery? A systematic literature review of published cost analyses. Obes Surg. 2017;27(8):2193. Scholar
  11. 11.
    Doble B, Wordsworth S, Rogers CA, Welbourn R, Byrne J, Blazeby JM. What are the real procedural costs of bariatric surgery? A systematic literature review of published cost analyses. Obes Surg. 2017;27(8):2179–92. Scholar
  12. 12.
    Finkelstein EA, Allaire BT, Globe D, Dixon JB. The business case for bariatric surgery revisited: a non-randomized case-control study. PLoS One. 2013;8(9):e75498. Scholar
  13. 13.
    Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9. Scholar
  14. 14.
    •• Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, et al. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess. 2018;22(68):1–246. This publication is the most-complete systematic review of the cost-effectiveness of bariatric surgery, lifestyle intervention, and medications in persons with severe obesity. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796–7. Scholar
  16. 16.
    Cremieux PY, Buchwald H, Shikora SA, Ghosh A, Yang HE, Buessing M. A study on the economic impact of bariatric surgery. Am J Manag Care. 2008;14(9):589–96.PubMedGoogle Scholar
  17. 17.
    Maciejewski ML, Arterburn DE. Cost-effectiveness of bariatric surgery. JAMA. 2013;310(7):742–3. Scholar
  18. 18.
    Banerjee S, Garrison LP Jr, Flum DR, Arterburn DE. Cost and health care utilization implications of bariatric surgery versus intensive lifestyle and medical intervention for type 2 diabetes. Obesity (Silver Spring). 2017;25(9):1499–508. Scholar
  19. 19.
    Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503. Scholar
  20. 20.
    Anselmino M, Bammer T, Fernandez Cebrian JM, Daoud F, Romagnoli G, Torres A. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II). Obes Surg. 2009;19(11):1542–9. Scholar
  21. 21.
    Ikramuddin S, Klingman D, Swan T, Minshall ME. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Am J Manag Care. 2009;15(9):607–15.PubMedGoogle Scholar
  22. 22.
    Keating CL, Dixon JB, Moodie ML, Peeters A, Bulfone L, Maglianno DJ, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis. Diabetes Care. 2009;32(4):567–74.CrossRefGoogle Scholar
  23. 23.
    Pollock RF, Muduma G, Valentine WJ. Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK. Diabetes Obes Metab. 2013;15(2):121–9. Scholar
  24. 24.
    Borisenko O, Adam D, Funch-Jensen P, Ahmed AR, Zhang R, Colpan Z, et al. Bariatric surgery can lead to net cost savings to health care systems: results from a comprehensive European decision analytic model. Obes Surg. 2015;25(9):1559–68. Scholar
  25. 25.
    •• Wentworth JM, Dalziel KM, O'Brien PE, Burton P, Shaba F, Clarke PM, et al. Cost-effectiveness of gastric band surgery for overweight but not obese adults with type 2 diabetes in the U.S. J Diabetes Complicat. 2017;31(7):1139–44. This publication was the first cost-effectiveness analysis of bariatric surgery in overweight (BMI 25-29 kg/m 2 ) patients with type 2 diabetes. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Gulliford MC, Charlton J, Prevost T, Booth H, Fildes A, Ashworth M, et al. Costs and outcomes of increasing access to bariatric surgery: cohort study and cost-effectiveness analysis using electronic health records. Value Health. 2017;20(1):85–92. Scholar
  27. 27.
    Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA. 2014;311(17):1778–86. Scholar
  28. 28.
    Alqahtani AR, Elahmedi MO, Al Qahtani A. Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(5):842–50. Scholar
  29. 29.
    Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, et al. Weight loss and health status 3 years after bariatric surgery in adolescents. N Engl J Med. 2016;374(2):113–23. Scholar
  30. 30.
    Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. Scholar
  31. 31.
    • American Diabetes Association. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S81–S9. This publication includes the U.S. guidelines recommending bariatric surgery for obese persons with type 2 diabetes. CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Public Health Economics ProgramRTI InternationalDurhamUSA

Personalised recommendations