• T Wu, WongS K HSKHDepartment of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China., B T T Law, E Grieve, O Wu, D K H Tong, D K W Leung, NgE K WEKW0000-0001-7219-5810Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.Department of Surgery, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, China., LamC L KCLK0000-0001-7536-8481Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China., and C K H Wong.
• Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China.
• Br J Surg. 2021 May 27; 108 (5): 554-565.

BackgroundBariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here.MethodsPopulation-based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006-2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co-morbidity Index (CCI) scores and co-morbidity rates were measured to compare changes in co-morbidities between surgically treated and control groups over 5 years. One-to-five propensity score matching was applied.ResultsOverall, 401 eligible surgical patients were matched with 1894 non-surgical patients. Direct medical costs were much higher for surgical than non-surgical patients in the index year (€36 752 and €5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5-year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5-year period, surgical patients had shorter length of stay in hospitals than non-surgical patients in year 2-5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose-lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose-lowering medications in year 2 (€973 versus €1395; P = 0.012).ConclusionBariatric surgery in obese patients with T2DM is expensive, but leads to an improved co-morbidity profile, and reduced length of hospitalization.© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.

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