Bariatric surgery is probably more efficacious than medical or lifestyle intervention for long-term weight loss and remission of diabetes. The ability of bariatric surgery to reduce expenditures sufficiently to achieve cost savings remains hotly debated, and in 2 early studies, it appeared cost-saving over a relatively short period of time.1,2 More recent studies,3,4 including an analysis of 29 820 BlueCross BlueShield enrollees published in the June issue of JAMA Surgery,5 show no evidence of cost savings. These results are consistent with prior cost-effectiveness evaluations6,7 that demonstrated cost-effectiveness—but not cost savings—for bariatric procedures compared with usual medical care or intensive lifestyle interventions (Box). Still, a critical policy question remains unanswered: does bariatric surgery need to be cost-effective (ie, more effective but more costly than usual care), or does it need to achieve the higher standard of cost savings (ie, more effective and less costly than usual care) to justify broader insurance coverage?
Maciejewski ML, Arterburn DE. Cost-effectiveness of Bariatric Surgery. JAMA. 2013;310(7):742-743. doi:10.1001/jama.2013.276131