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Abstract
Bariatric surgery is one of the major breakthroughs in diabetes care to have emerged since the discovery of insulin. In the 15 years since the first observational study, clinical trials and observational studies of bariatric surgery in diabetic patients have confirmed the beneficial effects of surgery (1). Since 2000, guidelines from the National Institutes of Health (NIH) have recommended bariatric surgery as an option for obesity treatment in adults with a BMI ≥35 kg/m2 and a serious comorbid condition (2). In 2009, the Centers for Medicare & Medicaid Services officially announced it would cover bariatric surgery for beneficiaries with morbid obesity and type 2 diabetes. While bariatric surgery can be beneficial, it is an expensive intervention costing at least $13,000 in the first year (3). In light of its high costs and potential benefits, understanding the cost-effectiveness of bariatric surgery for diabetes is critical for policy discussions regarding any ongoing or additional public health investment in bariatric surgery. The cost-effectiveness of bariatric surgery for diabetes has been evaluated in prior studies, but these studies have been limited by simplistic diabetes models (4–6) with parameter inputs derived from individual trials (5). Only one previous study of Roux-en-Y gastric bypass has accounted for the future complications of diabetes (7,8), and only one study has been conducted from the perspective of the U.S. (7). In this issue of Diabetes Care , Hoerger et al. (9) address many of these deficits in the existing literature and report on the most rigorously conducted cost-effectiveness analysis of bariatric surgery for diabetes to date. Using the Centers for Disease Control-Research Triangle Institute (CDC-RTI) Diabetes Cost-Effectiveness Model, the authors modeled the potential lifetime effects of bariatric surgery on diabetes by estimating rates of diabetes remission and relapse, as well as diabetes complications, …
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