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Obesity Surgery May Trim Drug Costs for Diabetics, Study Finds

Diabetics who undergo weight-loss surgery need fewer medications to control the condition and have lower health-care costs after the procedure, a study found.

Three-quarters of obese patients with Type 2 diabetes were able to stop insulin and other blood-sugar controlling drugs within six months of undergoing the stomach-limiting operation, also known as bariatric surgery, researchers at the Johns Hopkins University School of Medicine said in a study yesterday in the Archives of Surgery.

The findings suggest insurance should cover the $30,000 hospital treatment, which the study’s authors say appears to be the only intervention that can result in a sustained reversal of both obesity and Type 2 diabetes. Obesity costs Americans as much as $150 billion a year, the Atlanta-based U.S. Centers for Disease Control and Prevention said in a report this month.

“One of the central fears of people suddenly saying surgery is the solution is, how are we ever going to pay for it?” said Paul O’Brien, director of the Centre of Obesity Research and Education at Monash University in Melbourne, who wasn’t involved in the study. “When you look at that drop in health-care costs after surgery, they come right down.”

Bariatric surgery reduces stomach capacity, typically by stapling off the stomach and creating a much smaller pouch. The median cost of the surgery and hospitalization was $29,959, according to the authors, who said its use has tripled during the past five years.

Morbid Obesity

About 220,000 morbidly obese people in the U.S. had bariatric surgery last year, according to the American Society for Metabolic & Bariatric Surgery in Gainesville, Florida. In the current U.S. system, patients with Medicaid, the joint federal-state health program for low-income people, don’t have equal and uniform access to bariatric surgery, the Johns Hopkins researchers said.

“Our results suggest that insurance companies would do well to more readily cover bariatric surgery,” Marty Makary, an associate professor of surgery at Baltimore-based Johns Hopkins and the study’s leader, said in a statement.

“The cost to care for the average obese diabetic person in America is $10,000 a year, which could be cut to $1,800 with a very safe operation that eliminates more than 80 percent of the medications these individuals have depended on,” Makary said.

The authors studied 2,235 adults with Blue Cross/Blue Shield insurance plans across the U.S. who had Type 2 diabetes and underwent bariatric surgery from January 2002 to December 2005. Insurance claims data were studied to measure the use of diabetes medications before and after surgery, along with annual health-care costs.

Fewer Insulin Users

About 23 percent of participants were insulin-dependent before surgery and more than half took the generic treatment metformin to control diabetes. Within one year following surgery, the percentage of patients dependent on insulin dropped to 5.5 percent and the proportion on metformin plunged to 8.4 percent.

Total annual health-care costs increased by 9.7 percent in the year following the procedure, then decreased by 34 percent in the second year and by 71 percent in the third year, the authors found.

Insurers recover their costs for gastric surgery within two to four years for obese patients whose weight puts their lives in danger, a 2008 study in the American Journal of Managed Care found.

The research was funded by the Agency for Healthcare Research and Quality in Rockville, Maryland.

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