No Difference in Health Care Expenditures Between RYGB and Sleeve Gastrectomy Procedures

Expert discusses bariatric surgery for type 2 diabetes
Expert discusses bariatric surgery for type 2 diabetes
Investigators compared 4-year health care expenditures between Roux-en-Y gastric bypass and sleeve gastrectomy.

There are no statistically significant differences in mean health care expenditures between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy 4 years after the procedures, according to a study published in JAMA Network Open.

Residents of Ontario, Canada who received a publicly funded RYGB or sleeve gastrectomy procedure between March 1, 2010, and March 31, 2015, were included and followed until March 31, 2019. Data regarding publicly funded health care expenditures, subsequent hospitalizations, bariatric procedures, and mortality during the 4 years were collected.

Overall, 1624 participants who received either RYGB or sleeve gastrectomy were recruited. After propensity score matching, each cohort included 812 patients, 621 of whom were women, and 310 who were diagnosed with type 2 diabetes. Mean body mass index (BMI) of participants in the RYGB cohort was 51.9 kg/m2 (SD, 8.3 kg/m2) and was 51.9 kg/m2 (SD, 8.9 kg/m2) for the sleeve gastrectomy cohort.

In the 4 years postsurgery, the mean health care expenditures did not differ significantly, at $33,682 (SD, $31,169) for the RYGB group and $33,948 (SD, $32,633) for sleeve gastrectomy (P =.86). There were no statistical differences in readmissions during the 4 years of follow-up between groups; however, nonelective hospitalizations occurred more often in the RYGB group compared with sleeve gastrectomy (472 vs 339 hospitalizations; P =.002) during this time. More individuals in the sleeve gastrectomy group underwent a second bariatric procedure during follow-up (37 versus 8 patients; P <.001). There were no differences in all-cause mortality or total number of hospitalizations between groups.

There was no association between type of surgery and 4-year overall health care expenditures. The main factors contributing to increases in overall health care expenditures were a history of coronary artery disease (35% increase), chronic kidney disease (54% increase), and mental health admissions (67% increase).

Study limitations included the absence of data on medication costs, potential unmeasured confounding despite matching, the exclusion of non-publicly funded procedures like banding, inability to perform subgroup analysis, and a lack of power to detect differences in mortality. The study was also based on a cohort of patients from 2010 to 2015, which may no longer be generalizable to more recent patients. Finally, researchers did not include important patient-focused measures like individual costs and quality of life in their analysis.

According to researchers, “These results may help to inform patients, surgeons, and policy makers on the relative values of RYGB and sleeve gastrectomy.”


Tarride J-E, Doumouras AG, Hong D, et al. Comparison of 4-Year health care expenditures associated with Roux-en-Y gastric bypass vs sleeve gastrectomy. JAMA Netw Open. 2021;4(9):e2122079. doi: 10.1001/jamanetworkopen.2021.22079