NEW YORK (Reuters Health) – Surgically induced weight loss is cost-effective relative to conventional therapy for the management of type 2 diabetes in obese patients, both in the short term and projected over a patient’s lifetime, investigators in Melbourne, Australia, report in the April issue of Diabetes Care.

Results of a 2-year randomized controlled trial reported last year indicate that “surgically induced weight loss leads to the remission of type 2 diabetes in the majority of obese patients,” Catherine L. Keating at Monash University and co-authors note.

Using data from the trial, the team estimated the within-trial cost-efficacy of surgically induced remission of type 2 diabetes. Included were 60 patients with diabetes diagnosed within the previous 2 years and BMIs between 30 and 40. Thirty were assigned to placement of a laparoscopic adjustable gastric band, and 30 were assigned to best available medical management. Costs were reported in 2006 Australian dollars.

Diabetes remission was achieved by 22 patients (73%) treated surgically and 4 patients (13%) treated medically.

Over 2 years, surgical therapy cost an additional $10,000 per patient. Keating’s group estimates that each case of remitted diabetes cost an additional $16,600 over conventional therapy.

However, they note, “the comparable incremental cost-effectiveness ratio for conventional therapy relative to no intervention (no costs and no benefits) over the same time horizon is $25,500 per case of diabetes remitted.”

The authors suggest that “within a 2-year time horizon the surgical therapy program is below the currently accepted cost-effectiveness threshold.”

In a second paper in the journal, Keating and her associates developed a Markov model using the same data to extrapolate the costs and outcomes to the lifetime of the trial population.

“Relative to conventional therapy, surgically induced weight loss was a dominant alternative (associated with health care savings and health benefits) for managing type 2 diabetes in obese patients,” they report.

They calculate that surgical management was associated with health care savings of $2,400 and an additional 1.2 quality-adjusted life years per patient. Moreover, “this analysis suggests that after 10 years the return on investment of surgical therapy is fully recovered through savings in health care costs.”

Reference:
Diabetes Care 2009;32:567-574,580-584.