Insulin - the cost and benefit of bariatric surgery, told through a single medication.

I recently read a great article on Vox by Julia Belluz detailing the upward spiral of the cost of injectable insulin over the last several decades. One of the greatest advances in modern medicine -- sold for $1 by its discoverer and available in the 1990's for $2-4 per month -- now costs upwards of $450 per month depending on the formulation and manufacturer. Ms Belluz's reporting also details why this increase has happened -- not because of vastly better drugs, but because of few regulations to a free market approach to treating the crippling disease of diabetes.

While policymakers and the public at large are right to hope for fairer practices by pharmaceutical companies, bariatric surgeons are likewise justified in pointing out the cost-effectiveness of weight loss surgery, particularly gastric bypass, through the lens of insulin use. A 2015 study in Diabetes Care showed that 62% of all Type 2 diabetic patients taking insulin had ceased insulin use within 1 year following a gastric bypass. A more recent 5-year study in the New England Journal of Medicine (the STAMPEDE Trial) comparing gastric bypass plus medication to medication alone in the treatment of Type 2 diabetes showed conclusively that "...among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia.” These beneficial effects were durable even in patients with mild obesity (BMI 27-35) and that the effects of weight loss surgery on cancer, heart attack, kidney failure, blindness, and death would likely show similar results given the same scrutiny.

These insights support the facts that a temporary increase in health costs due to an elective weight loss surgery vastly outweigh the cost of decades of increasingly expensive insulin use. Considering the similarly dramatic improvements in other obesity-related diseases (see image below), one can only hope that the idea of cost-effectiveness as a barrier to coverage for bariatric surgery will soon be a thing of the past.