Roux-en-Y Gastric Bypass Compared to Glucagon-Like Peptide-1 Receptor Agonists is Associated with Lower Out-of-Pocket Costs in Insured Patients with Type 2 Diabetes and Obesity: A Matched Analysis Over Two Years - Scorecard - MDSpire
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Roux-en-Y Gastric Bypass Compared to Glucagon-Like Peptide-1 Receptor Agonists is Associated with Lower Out-of-Pocket Costs in Insured Patients with Type 2 Diabetes and Obesity: A Matched Analysis Over Two Years
Clinical Scorecard: A Comparative Analysis of Roux-en-Y Gastric Bypass and GLP-1 Receptor Agonists Reveals Lower Out-of-Pocket Expenses for Insured Individuals with Type 2 Diabetes and Obesity Over a Two-Year Period
At a Glance
Category
Detail
Condition
Severe obesity and type 2 diabetes (T2D)
Key Mechanisms
Roux-en-Y gastric bypass (RYGB) provides surgical weight loss and diabetes resolution; GLP-1 receptor agonists (GLP-1 RAs) promote weight loss and glycemic control pharmacologically
Target Population
Adults aged 21 to 65 years with class 2 or 3 obesity (BMI ≥ 35 kg/m2) and T2D, commercially insured
Care Setting
Outpatient and inpatient healthcare settings with insurance coverage for surgery and prescription medications
Key Highlights
RYGB leads to greater weight loss and higher rates of diabetes resolution compared to other bariatric surgeries but has higher out-of-pocket (OOP) costs than sleeve gastrectomy.
GLP-1 RAs require continuous prescription adherence with at least 80% days covered over two years to be considered effective treatment.
This study found that insured patients undergoing RYGB had lower OOP healthcare costs over two years compared to those treated with GLP-1 RAs.
Guideline-Based Recommendations
Diagnosis
Identify T2D using ICD-10 code E11.xx and confirm with pharmacy claims for diabetes medications.
Determine obesity class using BMI-related ICD-10 codes (Z68.35-Z68.39, Z68.4x) from inpatient and outpatient claims.
Management
Consider RYGB or GLP-1 RAs as treatment options for patients with class 2 or 3 obesity and T2D based on patient preference, tolerability, and financial implications.
Ensure continuous prescription adherence for GLP-1 RAs with minimal gaps (≤45 days) and ≥80% days covered over two years.
Monitoring & Follow-up
Monitor prescription refill patterns and insurance claims to assess adherence and ongoing treatment.
Track OOP costs including inpatient, outpatient, and pharmaceutical expenses over time.
Risks
Consider potential side effects and complications associated with RYGB surgery.
Evaluate tolerability and compliance challenges with GLP-1 RA pharmacotherapy.
Patient & Prescribing Data
Commercially insured adults with class 2 or 3 obesity and T2D, ages 21-65, with continuous insurance coverage and prescription plans.
Patients undergoing RYGB had no GLP-1 RA prescriptions filled, and GLP-1 RA patients had no bariatric procedures; continuous prescription adherence was required for GLP-1 RA cohort inclusion.
Clinical Best Practices
Use comprehensive claims data to confirm diagnosis and treatment adherence in patients with obesity and T2D.
Engage in shared decision-making considering treatment efficacy, side effects, durability, compliance, and financial burden.
Adjust OOP cost assessments for inflation and truncate extreme cost outliers to reduce bias in economic analyses.
