# Long-term Costs and Return on Investment for Bariatric Surgery

> **NIH NIH R01** · DUKE UNIVERSITY · 2021 · $681,841

## Abstract

ABSTRACT
 Bariatric surgery is the most effective treatment for severe obesity, yet only 1-2% of eligible patients
undergo surgery annually. This low rate of bariatric surgery uptake persists despite strong evidence of the high
cost of severe obesity and the superiority of bariatric procedures in inducing clinically significant and sustained
weight loss, prolonged survival, and major improvements in obesity-related health conditions [i.e., type 2
diabetes (T2DM)] when compared to usual medical care. Barriers to use of bariatric surgery include patient and
physician knowledge and attitudes towards these procedures; lack of resources for non-surgical treatment of
severe obesity; and high patient costs arising from inadequate insurance coverage. Inadequate coverage and
significant pre-surgical requirements is common among private insurers despite Medicare providing full coverage
for bariatric procedures for >20 years and evidence that bariatric surgery is cost-effective at <$50,000/QALY.
This continued gap in coverage of bariatric surgery appears to be driven by concerns about the long-term costs
of complications and surgery’s large potential budget impact, since ~15% of U.S. adults are eligible for bariatric
surgery and the cost per procedure is high ($20-30,000/procedure). As a result, payers may require evidence
that bariatric surgery is cost-saving before providing broader coverage.
 There are four major gaps in the economic evidence that are barriers to expansion of private insurance
coverage for bariatric surgery. We propose to address these evidence gaps by comparing the 5- and 10-year
expenditures of ~30,000 patients who previously underwent the two most common bariatric procedures (SG and
RYGB) and a large cohort (~90,000) of rigorously matched non-surgical patients with severe obesity from years
2005-2019 with follow-up through 2021. Over 5,000 surgical patients and 15,000 nonsurgical patients with index
dates before 2012 will have data at 10 years or beyond, making this the largest economic study to date and the
study with the longest follow-up. We propose to address three aims:
Aim 1: Compare 5- and 10-year changes in total costs of health care among patients undergoing SG and RYGB
 versus matched non-surgical patients with severe obesity.
Aim 2: Examine heterogeneity of the effect of surgery on costs to understand whether there are clinical
 subgroups of patients with severe obesity who have more favorable post-surgical cost trajectories.
 • Aim 2a: We will examine heterogeneity among all surgical patients and matched nonsurgical patients.
 • Aim 2b: We will examine heterogeneity among surgical patients with T2DM and their matches.
Aim 3: Estimate time to break-even for each subgroup identified in aim 2 to identify the return-on-investment
 over a 5- to 10-year time frame after accounting for the initial costs of surgery.

## Key facts

- **NIH application ID:** 10218157
- **Project number:** 5R01DK125380-02
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** David Eric Arterburn
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $681,841
- **Award type:** 5
- **Project period:** 2020-07-17 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10218157

## Citation

> US National Institutes of Health, RePORTER application 10218157, Long-term Costs and Return on Investment for Bariatric Surgery (5R01DK125380-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10218157. Licensed CC0.

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