Bariatric surgery costs significantly less than GLP-1 drugs over two years

A new real-world analysis of more than 90,000 patients with obesity and type 2 diabetes finds metabolic and bariatric surgery is costs significantly less than weekly injections of GLP-1 drugs over a two-year period, according to a new research presented today at the annual scientific meeting of the American Society for Metabolic and Bariatric Surgery (#ASMBS2026).

Researchers from Mayo Clinic Florida and Baylor College of Medicine in Texas found that GLP-1s end up costing thousands more per patient than surgery. In direct comparisons, total costs for GLP-1 treatment were about $17,000 more than sleeve gastrectomy ($58,600 vs. $41,400) and $7,200 more than gastric bypass ($58,600 vs. $51,300) after two years. Total costs, which varied by insurance type, reflect both the costs of the treatments and any expenses associated with subsequently unresolved obesity-related diseases and complications.

Data was drawn from the STATinMED RWD Insights all-payor claims database covering patients treated between 2017 and 2023. The study involved nearly 91,000 patients with obesity (BMI 35 or higher) and type 2 diabetes received either GLP-1 therapy or metabolic and bariatric surgery. After propensity score matching, researchers compared 4,931 patients treated with GLP-1s to an equal number of patients who underwent sleeve gastrectomy, and a separate matched group of 4,272 GLP-1 patients to an equal number who underwent gastric bypass.

As GLP-1 use becomes more widespread, understanding their long-term financial impact compared with metabolic and bariatric surgery is increasingly important. The assumption that drugs are more cost-effective because of their lower upfront costs doesn't hold up when extended over time, and especially when durability, adherence, and payer structure are considered." 

Michael A. Edwards, MD, lead study author, bariatric surgeon in the Department of General Surgery at the Mayo Clinic in Jacksonville

Dr. Edwards added that it's important for patients and providers to understand the overall value proposition, which should include consideration of the safety and effectiveness of the treatment, the patient's overall experience, and the cost of each care option over time.

"Obesity is a chronic disease and treatment decisions must consider long-term outcomes, affordability and sustainability. In this particular study, the more durable and clinically effective treatment -- metabolic and bariatric surgery -- is also the more affordable one." said Richard M. Peterson, MD, MPH, FASMBS, President, American Society for Metabolic and Bariatric Surgery (ASMBS) and Professor of Surgery at UT Health San Antonio, who was not involved in the study.

Metabolic and bariatric or weight-loss surgery, such as gastric bypass and sleeve gastrectomy, have been shown to be the most effective and long-lasting treatment for severe obesity and associated medical conditions. The operations improve or resolve diseases including type 2 diabetes, heart disease and high blood pressure and leads to significant and durable weight loss. Its safety profile is comparable to some of the safest and most commonly performed surgeries in the U.S., including gallbladder surgery, appendectomy and knee replacement. According to the ASMBS, less than 1% of those eligible for weight-loss surgery currently have it in any given year. More than 270,000 bariatric surgeries were performed in the U.S. in 2023, the latest estimates available.