Weight-loss surgery for obese teens found to be cost-effective over 10 years

Metabolic and bariatric surgery for teens with severe obesity was found to be cost-effective over 10 years, according to the new analysis from Ann & Robert H. Lurie Children's Hospital of Chicago published in JAMA Network Open. While long-term clinical benefits of weight-loss surgery for eligible teens have been well established, and it is recommended by the American Academy of Pediatrics, insurance coverage has been limited and few teens can take advantage of the surgery. This study strengthens the case for insurers and policymakers to support coverage and improve access to the procedure.

Severe obesity in adolescence is a serious and expensive health problem, and with the high risk for complications like diabetes, the long-term costs can be substantial. Our study shows that over time, weight-loss surgery emerges as the most cost-effective option when we consider years of better health that it provides, compared to non-surgical management for teens with severe obesity."

John Rode, MD, MS, lead author, Pediatric Surgery Research Fellow at Lurie Children's

Dr. Rode and colleagues built a detailed simulation model that follows teenagers with severe obesity over 10 years and compares two paths – one where they have surgery and one where they don't. The model included real-world data from previous studies on three key aspects of obesity care: what care costs (the surgery itself, follow-up care, and the ongoing treatment of obesity-related illnesses), how teens' health changes over time on each path, and how those changes affect their quality of life.

Type 2 diabetes was one of the most important factors considered. It is among the most serious and expensive conditions driven by severe obesity, as it often appears early and can last a lifetime. The model accounted for how likely teens are to develop diabetes on each path, and how surgery shifts those odds.

"Weight-loss surgery frequently sends type 2 diabetes into remission, sparing patients years of medication, complications and cost," said Dr. Rode. "Because diabetes is so expensive to manage over a lifetime, avoiding or reversing it is one of the biggest reasons that surgery provides such great value. Of course, an important caveat is that surgery remains a major case-by-case decision for teens who meet the criteria."

To see how reliable the results were, researchers ran the model 300,000 times, varying the inputs across the full range of real-world possibilities. Across those simulations, the pattern held – surgery consistently delivered more years of healthy life, at a cost per year that fell below what health systems consider a good value. That value was strongest for sleeve gastrectomy, which is one of the most common types of weight-loss surgery.

"Our model did not consider treatment with GLP-1s because long-term data are lacking for these therapies and they are typically prescribed for teens with less severe obesity, making it difficult to make robust comparisons at this time," explained Dr. Rode. "However, as long-term GLP-1 clinical outcome and cost data emerge, our study can serve as a benchmark for comparison with weight-loss surgery."