68 Influence of bariatric surgery on antidiabetic medications: An analysis of health insurance data in the context of the ACHT project-Obesity Care and Health Therapy

Zusammenfassung

Our analysis shows that metabolic-bariatric surgery leads to a relevant reduction in antidiabetic medications and their costs in everyday care. However, 3-year follow-up data is limited in this data set leading to wide confidence intervals. Mixed models help estimate mean costs and number of medications, but a higher number of patients would be preferable for estimates. With the introduction of the structured ACHT-program, other important aspects of care, such as access to local medical follow-up, psychological support and quality of life, will be evaluated.

Einleitung

Metabolic-bariatric surgery is the best evidence-based treatment for morbid obesity, especially if presenting with type 2 diabetes mellitus. ACHT is a project funded by the Innovation Fund of the G-BA to evaluate a structured postoperative follow-up program for patients insured by the AOK-Bayern. The objective of this analysis is to evaluate the baseline situation regarding changes in medication before and after bariatric surgery prior to the start of the ACHT study.

Material und Methodik

Based on insurance data from AOK-Bayern of patients who had bariatric surgery between 2016 and July, 2019 (n=1269), the effect of bariatric surgery on diabetes medications was evaluated. Medications costs and number of medications in the half-year before surgery were compared to values at 1.5 years and 3 years after surgery. Overall, 87% of patients had medication information available before and after surgery. Since 54% of patients had their operation in 2018 and 2019, only 44% of patients have medication data at 1.5 years after surgery and only 10% have data on medications 3 years after surgery. Thus, mixed regression models were used to account for differences in follow-up time and these were adjusted for age, sex, repeated measurements and data distribution.

Ergebnisse

We analyzed data of 1100 operated patients of which 31% received diabetes medications in the 0.5-years before surgery, 13% 1.5-years after surgery and 12% 3-years after surgery. Mean costs and number of diabetes medications were highest in the 0.5-years before surgery (301 € (95% CI: 244€; 370€) with an average of 3.0 drugs (95% CI: 2.6; 3.4)). These values significantly decreased to 54€ (33€; 87€) and 0.61 (0.46; 0.81) at 1.5-years and 51€ (33€; 87€) and 0,40 (0.21; 0.75) at 3-years, respectively, after surgery.

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Publication History

Article published online:
24 September 2021