Comparing Costs and Clinical Outcomes of Bariatric Surgery and Semaglutide for Obesity and Type 2 Diabetes

Key Takeaways:

• Bariatric surgery is more common among patients with higher body mass indexes (BMIs): Patients who received semaglutide were more likely to have lower BMIs and less comorbidities than patients who underwent bariatric surgery.
• Bariatric surgery has higher total care costs: Semaglutide was associated with higher out-of-pocket costs but lower total health care spending than bariatric surgery, illustrating the role insurance coverage plays in care costs and treatment decision-making.
• Bariatric surgery has lower rates of health care utilization: Overall, bariatric surgery was associated with less health care utilization than semaglutide, reflecting its long-term effectiveness in comorbidity management.

Although semaglutide is an effective therapy for weight loss and diabetes management among patients with obesity and type 2 diabetes (T2D), therapy discontinuation is high due to high care costs and limited insurance coverage. On the other hand, bariatric surgery has similar efficacy and wider coverage, but utilization among eligible patients is incredibly low at less than 1%.

Researchers conducted a real-world comparison of health care costs and utilization associated with semaglutide and bariatric surgery among patients with obesity and T2D. The study focused on 2 common bariatric operations: sleeve gastrectomy and gastric bypass.

Economic outcomes included out-of-pocket spending and total health care costs. Clinical outcomes included emergency department (ED) visits, hospitalizations, and major adverse cardiovascular events (MACE).

Using the Merative MarketScan Commercial Claims and Encounters database, researchers identified 22 995 adults with obesity and T2D who received bariatric surgery or semaglutide injections between January 2016 and December 2021.

Among the 22 995 patients included in the study, 10 126 underwent bariatric surgery (3295 had gastric bypass; 6831 had sleeve gastrectomy) and 12 869 initiated semaglutide therapy.

BMI and Comorbidity Influence Treatment Patterns

On average, patients receiving semaglutide had a lower body mass index (BMI) than patients who had bariatric surgery. BMIs higher than 45 were more common among bariatric patients.

Complications from diabetes occurred more frequently among semaglutide patients (42.1%) than patients with gastric bypass (41%) or sleeve gastrectomy (31.8%). However, comorbidities such as liver disease, peptic ulcer disease, and chronic pulmonary disease were more common among bariatric patients.

Economic and Clinical Outcomes

In an adjusted analysis, semaglutide was associated with higher out-of-pocket costs than bariatric surgery after 3 years. Both treatments maintained similar spending during year 1, but out-of-pocket spending for semaglutide surpassed both gastric bypass and sleeve gastrectomy by year 3.

Although semaglutide had higher out-of-pocket spending, bariatric surgery resulted in higher total care costs. This discrepancy is likely due to the high upfront cost of surgery compared to reoccurring medication payments. Additionally, bariatric surgery is more likely to be covered by insurance, which would result in less out-of-pocket costs.

Patients who underwent gastric bypass had more ED visits and hospitalizations than those who received semaglutide. However, this group had a lower risk of MACE. Sleeve gastrectomy patients also had a lower risk of MACE and hospitalization compared to semaglutide patients.

Overall, sleeve gastrectomy was associated with lower health care utilization than semaglutide, and gastric bypass resulted in fewer cardiovascular complications. The weight loss associated with bariatric surgery improves management of comorbidities, which could explain the decreased rates of health care utilization.

Determining Appropriate Treatment

The study’s findings indicate that bariatric surgery has greater long-term efficacy and safety than semaglutide but comes with higher care costs. Physicians must discuss the costs and clinical benefits of each treatment with patients to determine which therapy is best for them.

According to the researchers, “These findings support bariatric surgery for patients sensitive to OOP costs and those who prioritize long-term cardiovascular risk reduction. They also support semaglutide for patients who prioritize avoiding short-term complications.”

Reference

Chhabra KR, Gencerliler N, Orandi BJ, et al. Semaglutide vs. bariatric surgery: comparing costs and clinical outcomes in patients with diabetes and obesity. Obesity. 2026;34(1):65-76. doi:10.1002/oby.70209