Background

Though bariatric surgery is highly effective in achieving type 2 diabetes mellitus (T2DM) remission in obese individuals on average, recent evidence indicates heterogeneous rates of T2DM remission based on individual patient characteristics (e.g., age, BMI, severity of T2DM) as well as surgery type (e.g., Roux-en Y gastric bypass, sleeve gastrectomy). With the increasing support to expand eligibility criteria from body mass index (BMI) ≥ 35kg/m2 to 30 or below, there is growing need for a personalized approach to maximize therapeutic benefits and minimize adverse events. We provide the first estimate of the potential societal value of a personalized approach to bariatric surgery for people with diabetes.

Methods

Using the Future American Microsimulation (FAM) model, we quantified the social, private, and public-finance life-values of improved targeting of bariatric surgery in a cohort of obese American adults diagnosed with T2DM aged >25 under both current and expanded eligibility criteria (BMI≥35kg/m2 and 30kg/m2, respectively).

Results

Targeting improved per capita values of Incremental Cost Ratio (ICER) over non-targeting under both current ($-83,324/QALY vs $-79,009/QALY) and expanded ($-71,832/QALY, vs $-42,665/QALY) eligibility criteria, though all scenarios are cost-saving. The average lifetime net social value per capita for targeting was 20% ($257,998 vs $210,949) and 50% greater ($274,514 vs $177,958) than non-targeted under current and expanded eligibility, representing total lifetime cohort gains of $159.1B and $542.4B, respectively.

Conclusions

Appropriately targeting surgery type to patient characteristics can potentially improve the net social value of bariatric surgery and reduce adverse events, and may be particularly valuable under expanded eligibility criteria.