Surgery for Obesity and Related Diseases · Sep 23, 2026

Total healthcare costs and cost savings after bariatric surgery and glucagon-like peptide-1 receptor agonist treatment for obesity and diabetes vary with insurance coverage

By Alomari ME, Wall-Wieler E, Liu Y et al.

BACKGROUND: Glucagon-like peptide-1 receptor agonist (GLP-1-RA) options continue to evolve. Given different levels of reimbursement across insurance payors, we compared healthcare costs across payors 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 II or III 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. Current Procedural Terminology 4 and International Classification of Diseases, Tenth Revision, codes identified MBS, and national drug codes identified GLP-1-RA prescriptions. The primary outcome was 2-year overall healthcare cost for MBS and GLP-1-RA treatments stratified by insurance type. RESULTS: Ninety thousand seven hundred sixty nine individuals met inclusion criteria; 5%, 64.1%, and 30.4% were treated with GLP-1-RAs, SG, and RYGB, respectively. A propensity-matched analysis compared 4931 GLP-1-RA and SG patients. Healthcare costs for GLP-1-RAs and SG were higher among noncommercial payors than those among commercial payors, more so for GLP-1-RAs. Two-year total costs were significantly lower for SG than those for GLP-1-RAs across all insurance payors (P < .01; delta: $11,310-$18,918). Medicaid insurance had the greatest cost savings ($18,927, P < .01). The propensity-matched analysis also compared 4271 GLP-1-RA and RYGB patients. Two-year total costs varied by insurance type and were similar for RYGB and GLP-1-RA (P > .05), except for the commercial insurance cohort having a significant lower cost for RYGB than for GLP-1-RAs (delta: $4973, P < .01). CONCLUSION: Costs associated with both MBS and GLP-1-RAs were higher with Medicaid and Medicare than with commercial insurance. SG and RYGB were associated with cost savings compared with GLP-1-RA treatment across most payor types.

doi.org/10.1016/j.soard.2026.09.012 Open access PubMed 42892602 Interventions