Total Healthcare Costs and Cost Savings after Bariatric Surgery and Glucagon Like Peptide (GLP-1) Receptor Agonists Treatment for Obesity and Diabetes Vary with Insurance Coverage

Background Glucagon like peptide receptor agonists (GLP-1-RAs) options continue to evolve. Given different levels of reimbursement across insurance payers, we compared healthcare costs across payers for patients treated with metabolic and bariatric surgery (MBS) or GLP-1-RAs. Setting Academic Health Center Methods Using the STATinMED RWD Insights all-payor claims database, we performed a retrospective 1:1 propensity matched cohort analysis of patients with class 2 or 3 obesity and type 2 diabetes (T2D) treated with sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) or GLP-1-RAs from 2017 to 2023. CPT-4 and ICD-10 codes identified MBS and national drug codes identified GLP-1RAs prescriptions. Primary outcome was two-year overall healthcare cost for MBS and GLP-1 RAs treatments stratified by insurance type. Results 90,769 individuals met inclusion criteria. 5%, 64.1%, and 30.4% were treated with GLP-1-RAs, SG, and RYGB, respectively. Propensity matched analysis compared 4,931 GLP-1-RAs and SG patients. Healthcare costs for GLP-1-RAs and SG were higher amongst non-commercial payers compared to commercial payers, more so for GLP-1-RAs. Two-year total costs were significantly lower for SG compared to GLP-1-RAs across all insurance payers (p<0.01) (delta: $11,310-$18,918). Medicaid insurance had the greatest cost-savings ($18,927, p<0.01). Propensity matched analysis also compared 4,271 GLP-1-RAs and RYGB patients. Two-year total costs varied by insurance-type and were similar for RYGB and GLP-1RAs (p>0.05), except for the commercial insurance cohort having a significant lower cost for RYGB compared to GLP-1RAs (delta: $4973, p<0.01). Conclusion Costs associated with both MBS and GLP-1-RAs were higher with Medicaid and Medicare compared to commercial insurance. SG and RYGB were associated with cost savings, compared to GLP-1-RAs treatment across most payor types.