Christopher McGowan’s Post

Interesting article regarding GLP-1’s and Bariatric surgery. What’s more interesting is seeing how medical professionals determine how to balance the two.

A commercial insurance dataset of 1.6 million patients with obesity [though not diabetes] published in JAMA Network Open reported just over 5,000 [0.3%] underwent bariatric surgery, and 81,000 [5%] were on a GLP-1 drug. Over the 2022-2023 period of study, there was a 132.6% increase in patients prescribed GLP1 meds, and a 25.6% decrease in patients undergoing metabolic bariatric surgery. At a broader landscape view, let’s focus on the massive addressable market for obesity treatment, with less than 6% the study population receiving GLP1 drugs, or surgery – truly an imperative for all boats to rise. https://lnkd.in/ePBfGnEs

This is a perfect example of disrupting a market. Not that long ago, I remember sitting through presentations on the market for bariatric surgery. At the time, there were about 200,000 bariatric surgeries per year in the U.S., which was <2% of the eligible patient population. The incidence of morbid obesity was projected to grow, and the idea was how to develop the market to treat more patients. I remember thinking that no matter how effective surgery is as a solution, it's not scalable to the size of the population who could benefit from it! Such an opportunity invites disruption, which these GLP-1 drugs are doing to the market! https://lnkd.in/ekba86Jz

Sharing a new study with Ateev Mehrotra. Among a cohort of commercially insured patients with obesity from 2022-2023, we found a 130% increase in the prescribing of GLP-1 medications. During the same time period, there was a 26% decline in bariatric surgery procedures such as sleeve gastrectomy and gastric bypass. However, an overwhelming majority of patients with obesity were neither prescribed GLP-1 medications or underwent surgery, suggesting an ongoing unmet burden. The decrease in bariatric surgical volume is concerning and corroborates anecdotal reports of hospitals shutting down bariatric surgery programs. Still a lot of barriers to access remain for patients for both GLP-1 medications and surgery, and more work is needed to ensure equitable access so patients can benefit from multidisciplinary evaluation and potentially multimodal treatment that meet their personal health goals. Read more https://lnkd.in/e5svPAeq

Interesting study comparing the impact of GLP-1 drugs on bariatric surgery rates. GLP-1 utilization more than doubled 2022 to 2023 while bariatric surgery rates dropped by a quarter. While this could be good news for patients, it could also lead to significant cost increases for employers. #glp1 #medicalcosts

Miriam E. Tucker at Medscape suggests ‘GLP-1 Costs May Ease Restrictions to Bariatric Surgery.’ For example, Geisinger Health of Pennsylvania and Blue Cross Blue Shield of Massachusetts expanded BMI eligibility for bariatric surgery procedures, while Blue Cross Blue Shield of Michigan dropped prior authorization requirements. This may be in response to the high costs of GLP-1 medications, and a lack of data on cost-effectiveness. However, Dr. Christopher Still at Geisinger Medical Center said ‘…Geisinger Health Plan's change in May 2023 to lower the BMI surgery eligibility cutoff from 35 to 30 for people with comorbidities was not related to the cost of GLP-1 drugs…’ and more focused upon the effective and enduring treatment of obesity and its co-morbidities. The Geisinger Health Plan does not currently cover anti-obesity medications.  Health economist James Chambers at Tufts University says ‘…So now that you have these expensive drugs, it's not that surgeries become less expensive, but it does make you interpret the cost differently.’ Cristy Gallagher, at The STOP Obesity Alliance at the The George Washington University- Milken Institute School of Public Health , added ‘...you will not see a decrease in bariatric surgery in the near term, by any means.’ I agree wholeheartedly with Ted Kyle – it is not an either/or proposition – we need to think of it as the right treatment for the right patient at the right time – just as we take care of patients with cancer – radiotherapy, chemotherapy and surgery are all combined to achieve cure. We need to be bullish ‘…toward more integrated approaches to obesity…’ with surgery as a key tenet of care. https://lnkd.in/ec5p9TkU

New research presented at the 2024 American College of Surgeons Clinical Congress highlights an important finding: combining bariatric surgery with GLP-1 receptor agonist medications (such as Saxenda and Wegovy) is more cost-effective in the long run than relying on medication alone. While GLP-1 RA medications are effective, they require ongoing use and can cost thousands each year. Bariatric surgery, however, not only adds years of quality life but, when paired with these medications, leads to even better outcomes at a lower overall cost. As Dr. Joseph Sanchez, the study’s lead author, noted, “Undergoing bariatric surgery is more cost-effective in the long run than maintaining these medications for the remainder of an individual’s life.” Moreover, using GLP-1 RA before surgery could make operations safer for patients with a BMI greater than 50. This new research opens the door to a more holistic, cost-effective approach to long-term weight management. News Medical https://lnkd.in/g_j5UYnG

The researchers observed that semaglutide led to a consistent reduction in major adverse cardiovascular events (MACE) in the CABG and non-CABG groups, but the absolute risk reduction of MACE was greater in those who’d had bypass graft surgery: 2.3% vs. 1%. In this study, MACE included non-fatal stroke, non-fatal heart attack, hospitalization for heart failure, death from a heart-related cause and all-cause death. The magnitude of the benefit of semaglutide on the incidence of non-fatal heart attacks was higher in those with a history of CABG compared to those without. Also, as a positive ‘side benefit,’ semaglutide was also noted to reduce the incidence of diabetes in the group who’d had CABG surgery.

Exparel is the only FDA-approved single-dose regional analgesic to safely demonstrate four days of superiority versus bupivacaine in two clinical studies — New indications for use as an adductor canal block and sciatic nerve block in the popliteal fossa will significantly extend reach within more than 3 million lower extremity procedures TAMPA, Fla., Nov. 10, 2023 (GLOBE NEWSWIRE) — Pacira BioSciences, Inc. (NASDAQ: PCRX), the industry leader in its commitment to non-opioid pain management and regenerative health solutions, today announced that the U.S. Food and Drug Administration (FDA) has approved its supplemental new drug application (sNDA) to expand the Exparel® (bupivacaine liposome injectable suspension) label to include administration in adults as an adductor canal block and a sciatic nerve block in the popliteal fossa. An adductor canal block is used for anesthesia and analgesia for surgery of the knee, medial lower leg, and ankle surgeries. A sciatic nerve block in the popliteal fossa is used for anesthesia and analgesia for foot, ankle, achilles tendon, and other lower leg surgeries. “We are thrilled that today’s approval offers clinicians and patients another option for achieving long-lasting non-opioid pain control with Exparel and an increased ability to transition procedures to the ambulatory environment,” said Dave Stack, chief executive officer and chairman of Pacira BioSciences. “In line with our corporate mission to provide a non-opioid to as many patients as possible, this new indication provides additional flexibility in the use of Exparel as a regional analgesic for more than 3 million lower extremity procedures annually, further increasing the utility of Exparel for major orthopedic procedures.” The approval is supported by two successful randomized, double-blind, active-controlled, multicenter Phase 3 studies designed to evaluate the efficacy, safety, and pharmacokinetics of Exparel versus bupivacaine HCl. One study evaluated Exparel as a single-dose adductor canal block and the second study evaluated Exparel as a single-dose sciatic nerve block in the popliteal fossa. Both studies met their primary endpoints by demonstrating a statistically significant reduction in cumulative pain scores from 0 to 96 hours compared with bupivacaine HCl (P<0.01). Additionally, Exparel achieved statistical significance for the studies’ secondary endpoint of reduced postsurgical opioid consumption (P<0.01). Exparel as a sciatic nerve block in the popliteal fossa also achieved statistical significance for the percentage of opioid-free subjects (P<0.01). In both studies, Exparel maintained a safety profile consistent with bupivacaine HCl. “The addition of these new blocks, coupled with the previously approved interscalene brachial plexus nerve block and the ability to utilize Exparel as a fascial plane block provides clinicians with a wide array of applications to treat postsurgical pain with long-lasting,

The researchers observed that semaglutide led to a consistent reduction in major adverse cardiovascular events (MACE) in the CABG and non-CABG groups, but the absolute risk reduction of MACE was greater in those who’d had bypass graft surgery: 2.3% vs. 1%. In this study, MACE included non-fatal stroke, non-fatal heart attack, hospitalization for heart failure, death from a heart-related cause and all-cause death. The magnitude of the benefit of semaglutide on the incidence of non-fatal heart attacks was higher in those with a history of CABG compared to those without. Also, as a positive ‘side benefit,’ semaglutide was also noted to reduce the incidence of diabetes in the group who’d had CABG surgery. https://lnkd.in/g9sKjA3S