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

Jan 4, 2026Obesity surgery

Gastric Bypass Surgery Linked to Lower Out-of-Pocket Costs than Diabetes Medication in Insured Patients with Type 2 Diabetes and Obesity Over Two Years

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Abstract

Patients treated with Roux-en-Y gastric bypass (RYGB) spent $704 less in out-of-pocket costs than those treated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) after two years.

At one year after treatment, healthcare costs were similar for RYGB ($2,301) and GLP-1 RAs ($2,179) patients.
From one to two years after treatment, out-of-pocket costs were significantly lower for the RYGB group ($1,277) compared to the GLP-1 RAs group ($2,104).
The difference in out-of-pocket spending two years after treatment initiation was statistically significant (p < 0.01).

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OBJECTIVE: To evaluate two-year costs to insured patients treated with Roux-en-Y gastric bypass (RYGB) or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for type 2 diabetes (T2D) and obesity.

METHODS: Using the 2017 to 2023 Merative™ claims database, we identified adult patients with severe obesity and T2D who were treated with a RYGB or GLP-1 RAs. Patients with RYGB had no treatment with GLP-1 RAs, and those who received GLP-1 RAs therapy with tirzepatide or semaglutide for ≥ 2 years had no metabolic and bariatric surgery (MBS) procedures. The study cohorts were matched on demographics including obesity, associated medical problems, and baseline direct or out-of-pocket (OOP) costs to patients in the year prior to treatment initiation. Direct costs included those from outpatient services, inpatient admissions, and outpatient prescription filled that were paid directly by patients. We compared this cost up to two years after treatment initiation using paired t-tests.

RESULTS: 1012 matched RYGB and GLP-1 RAs patients were analyzed, including 35% male. At 1-year after treatment initiation, healthcare costs paid directly by patients were similar for the RYGB ($2,301) and GLP-1 RAs ($2,179) (delta = $122, p = 0.15) cohorts. From one to two years after index treatment date, OOP costs were significantly lower in the RYGB treatment group ($1,277 vs. $2,104, p < 0.01). Two years after treatment initiation, RYGB patients spent $704 less in OOP costs than similar patients treated with GLP-1 RAs medications (p < 0.01).

CONCLUSIONS: Direct OOP healthcare costs were lower for RYGB compared to treatment with GLP-1 RAs two years after treatment initiation.

Key numbers

$704

Out-of-Pocket Cost Savings

Average cost difference between RYGB and GLP-1 RAs patients at two years.

$2,301

First-Year Out-of-Pocket Costs

Average out-of-pocket costs for RYGB patients in the first year.

$1,277

Second-Year Out-of-Pocket Costs

Average out-of-pocket costs for RYGB patients in the second year.

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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

Abstract

Key numbers

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