Cost-Efficacy of Surgically Induced Weight Loss for the Management of Type 2 Diabetes

A randomized controlled trial

  1. Catherine L. Keating, MPH1,2,
  2. John B. Dixon, MBBS, PHD, FRACGP1,3,
  3. Marjory L. Moodie, DRPH2,
  4. Anna Peeters, PHD1,4,
  5. Julie Playfair, RN1 and
  6. Paul E. O'Brien, MD, FRACS1
  1. 1Centre for Obesity Research and Education, Monash University, Melbourne, Australia;
  2. 2Health Economics Unit, Public Health Research Evaluation and Policy Cluster, Deakin University, Melbourne, Australia;
  3. 3Baker IDI Heart and Diabetes Institute, Melbourne, Australia;
  4. 4Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
  1. Corresponding author: Catherine Keating, catherine.keating{at}


OBJECTIVE To determine the within-trial cost-efficacy of surgical therapy relative to conventional therapy for achieving remission of recently diagnosed type 2 diabetes in class I and II obese patients.

RESEARCH DESIGN AND METHODS Efficacy results were derived from a 2-year randomized controlled trial. A health sector perspective was adopted, and within-trial intervention costs included gastric banding surgery, mitigation of complications, outpatient medical consultations, medical investigations, pathology, weight loss therapies, and medication. Resource use was measured based on data drawn from a trial database and patient medical records and valued based on private hospital costs and government schedules in 2006 Australian dollars (AUD). An incremental cost-effectiveness analysis was undertaken.

RESULTS Mean 2-year intervention costs per patient were 13,400 AUD for surgical therapy and 3,400 AUD for conventional therapy, with laparoscopic adjustable gastric band (LAGB) surgery accounting for 85% of the difference. Outpatient medical consultation costs were three times higher for surgical patients, whereas medication costs were 1.5 times higher for conventional patients. The cost differences were primarily in the first 6 months of the trial. Relative to conventional therapy, the incremental cost-effectiveness ratio for surgical therapy was 16,600 AUD per case of diabetes remitted (currency exchange: 1 AUD = 0.74 USD).

CONCLUSIONS Surgical therapy appears to be a cost-effective option for managing type 2 diabetes in class I and II obese patients.


  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received September 23, 2008.
    • Accepted January 8, 2009.
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  1. Diabetes Care vol. 32 no. 4 580-584
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