June 2, 2016

expert reaction to two posters being presented at the European Obesity Summit, one on bariatric surgery for type 2 diabetes and estimated NHS cost saving*, and one on mortality in obese people that have surgery versus those that don’tǂ

Two posters at the European Obesity Summit have presented results on bariatric surgery, with one reporting its financial and health benefits when applied to type 2 diabetes, and another reporting lower mortality for obese individuals who undergo the surgery.

Comment on poster on bariatric surgery for type 2 diabetes and estimated NHS cost saving*:

Prof. Mark Baker, Centre for Clinical Practice director at NICE, said:

“The evidence of benefit is clear but the duration of benefit remains uncertain and the overall cost-effectiveness is likely to be more complex than the assumptions made by the authors.”

Prof. Nick Finer, Honorary Professor in the National Centre for Cardiovascular Prevention and Outcome at UCL, and Senior Principal Clinical Scientist with Novo Nordisk, said:

“Both these studies add to the solid evidence we already had to support the use of bariatric surgery as a cost effective treatment for people with diabetes and obesity.

“The data from the Worcestershire Royal Hospital (from the poster on bariatric surgery in type 2 diabetes)* are however probably overly optimistic since it is known that with increasing time after surgery diabetes recurs in a substantial number of people initially able to discontinue treatment. There are also emerging costs for managing nutritional and metabolic complications that can occur over time in a minority of patients.

“These facts however do not undermine the real benefits that surgery offers as shown by the Swedish reports at 5-6 years of follow-up from the poster on mortality after bariatric surgery for obesity^ǂ.”

Comment on poster on bariatric surgery for type 2 diabetes and estimated NHS cost saving*:

Prof Francesco Rubino, Chair in Metabolic and Bariatric Surgery, King’s College London and Consultant Surgeon, King’s College Hospital, said:

“The results presented in this poster need to be interpreted with caution; the study has not been through peer review and isn’t yet published in a journal, the study is small, and it also makes assumptions on lifetime health expenditure based on data from only a short- to mid-term follow up. It is unclear if and how the researchers computed the risk of diabetes relapse over time, which could require re-start or increase in medicalisation of patients with initial remission of the disease.

“On the other one hand, however, diabetic patients are often affected by a host of associated metabolic conditions such as abnormal blood lipid levels and high blood pressure, which require expensive drug treatment. Randomised clinical trials have shown that surgery can reduce medication usage across the board, not just diabetes (glucose-lowering) drugs. This may further increase the potential reduction of overall healthcare costs in patients who undergo metabolic surgery.

“Although the figures need to be taken with caution, the study is consistent with prior investigations showing that surgery is a highly-cost effective therapy for patients with type 2 diabetes.

“Type 2 diabetes cannot be left untreated because it is a disease that can cause severe complications and increase mortality. The question of whether surgery saves money or not is ill-conceived. If surgery is more effective than other available treatments in certain patients with type 2 diabetes, as clinical trials show, then it is quite obvious that when using expensive medications when they are not achieving therapeutic targets necessary to reduce risk of diabetes complication, investing into surgery makes both medical and economic sense. We don’t necessarily expect a return of investment from almost any therapy. We expect treatments to be effective and affordable. I am not sure whether the figures of the study are accurate, but it is safe to say that surgery may be at least as affordable if not more so than a lifetime of medical treatment in some patients. That alone should suggest to use it as often as medically indicated. If you can also save money in some patients that is a bonus but not the only reason why we should consider surgery as an approach to treat a deadly disease such as diabetes.”

Comment on poster on mortality in obese people that have bariatric surgery versus those that don’t^ǂ:

Prof. Francesco Rubino, Chair in Metabolic and Bariatric Surgery, King’s College London and Consultant Surgeon, King’s College Hospital, said:

“As with any non-randomised trial this study has limitations. However, the results are consistent with those of similar other studies from Sweden and from the USA which had already documented how bariatric/metabolic surgery is associated with decreased mortality from all causes, especially from diabetes, cardiovascular disease and cancer. Healthcare regulators should introduce policies that facilitate and expedite access to surgery, when indicated, and remove the many unnecessary hurdles that currently prevent access to this life-saving treatment option for the vast majority of surgical candidates.”

*‘Bariatric surgery in type 2 diabetics: the financial impact on the local health economy’ by S Chambers et al. is a poster presented at the European Obesity Summit. 

^ǂ ‘Reduced overall mortality following bariatric surgery’ by Christina E Persson et al. is a poster being presented at the European Obesity Summit. 

Declared interests

Prof. Nick Finer: Prof Finer is employed by Novo Nordisk and served on the Clinical Reference Group that before it was disbanded advised NHS England on Bariatric surgery.

Prof. Francesco Rubino: Funded by NIHR, on the Scientific Advisory Board for NGM Biopharmaceauticals, & for Fractyl P Laboratories. Receives consulting fees from Medtronic and Ethicon.