Sleeve Gastrectomy Beat GLP-1s on Two-Year Cost by $12,794 in a Study Intuitive Surgical Funded

A study published online on 23 September 2026 in Surgery for Obesity and Related Diseases, an ASMBS 2026 Top Paper, compared two-year total healthcare costs for adults with class 2 or 3 obesity and type 2 diabetes treated with sleeve gastrectomy, gastric bypass or GLP-1 drugs. It used STATinMED all-payer claims from 2017 to 2023, and 90,769 people met the criteria.
Across 4,931 matched pairs, sleeve gastrectomy patients cost $12,794 less over two years than GLP-1 patients ($48,588 against $61,382). The gap was significant for commercial, Medicaid and both Medicare groups, from $11,310 to $18,918. Gastric bypass, across 4,271 pairs, cost $4,013 less overall, significant only for commercial insurance.
The GLP-1 cohort had to fill prescriptions continuously for two years, with no gap over 45 days, which cut eligible drug users from 70,400 to 4,998. Fills were 76.7% Ozempic, 11.3% Rybelsus, 11.1% Mounjaro and 0.9% Wegovy, and matched GLP-1 patients averaged $42,708 in pharmacy costs over two years.
Intuitive Surgical funded access to the database. Three of the five authors are Intuitive employees, and the senior author, from Mayo Clinic, has received a speaking honorarium from the company. The abstract gives the Medicaid saving as $18,927; the paper’s table shows $18,918.

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The cost gap rests on drug prices that have already moved, in a study whose funder sells surgical systems.

The pharmacy bill is the whole story, and it is dated. $42,708 over two years is about $1,780 a month, on 2017 to 2023 claims. The authors concede that direct prices below list may inflate real-world GLP-1 costs. Lilly’s HHS agreement now sets $245 a month for Zepbound, Mounjaro and orforglipron under the BALANCE model, about $5,880 over 24 months, although this cohort mostly used Ozempic.
The design compares surgery with the costliest way to use a GLP-1. The authors call their adherent-only cohort a best case for drugs, because it excludes the sunk costs of patients who stop. It also means surgery is set against two years of continuous full-price therapy, and it drops patients who stop the drug and stop paying for it.
Medicaid is where the study claims the most and where prices are moving fastest. The largest saving, $18,918, is in Medicaid, the program where GENEROUS and BALANCE are now resetting GLP-1 prices. With the funder and three authors from Intuitive, payers will want the analysis rerun on current net prices before it shapes coverage decisions.