1017-OR: Cost-Effectiveness of Bariatric Surgery for Preventing Diabetes in U.S. Adults with Prediabetes and Severe Obesity: A Simulation Study

Introduction and Objective: Bariatric surgery improves weight and glycemic outcomes, but its cost-effectiveness (CE) for adults with prediabetes and severe obesity remains unclear. We evaluated the CE of bariatric surgery for diabetes prevention in this population. Methods: We estimated 20-year CE of Roux-en-Y gastric bypass and sleeve gastrectomy among U.S. adults aged ≥18 years with prediabetes and body mass index (BMI) ≥35 kg/m², compared with annual 30-minute obesity counseling. We used the validated CDC-RTI simulation model and a population derived from the 2017-2020 National Health and Nutrition Examination Survey. Data on effectiveness, perioperative mortality, and costs were obtained from published literature. Incremental cost-effectiveness ratios (ICERs) were assessed from a healthcare sector perspective and expressed as cost per quality-adjusted life-year (QALY), using a willingness-to-pay threshold of $100,000 per QALY. Results: Both procedures were associated with gains in life-years and QALYs compared with counseling. ICERs ranged from cost-saving to $15,413 per QALY gained, with variation across subgroups defined by age, BMI, and cardiovascular disease status. Conclusion: Over 20 years, bariatric surgery may be cost-effective and, in some subgroups, cost-saving for preventing diabetes among adults with prediabetes and severe obesity, informing coverage and guideline considerations for high-risk populations. Disclosure S. Tang: None. H. Shao: None. Y.J. Cheng: None. P. Zhang: None.