Cost-effectiveness analysis: GLP-1 agonists vs bariatric surgery (ICER 2026)

HealthEcon_DC said:

This is the one where the stakes are high and the answer is simple: tell the anaesthetist.

HealthEcon_DC said:

...surgery and anaesthesia should be combined with bariatric surgery...

This is actually an active area of research. Some bariatric programs are using GLP-1 agonists:

1. Pre-operatively to reduce liver size and surgical risk
2. Post-operatively to enhance and maintain weight loss
3. As an alternative for patients who don't qualify for or want surgery

The combination approach makes physiological sense — surgery addresses anatomy, GLP-1s address neurohormonal signaling. Early data on the combination is promising but we need larger studies.

Following on from Dr.RheumBOS — and this may be the naive question:

What actually works on a prior-authorisation denial, as opposed to the list of things that sound like they should work?

anders_CPH said:

HealthEcon_DC said: ...surgery and anaesthesia should be combined with bariatric surgery...

Timing surgery and anaesthesia around surgery: my surgeon required me to stop GLP-1 agonists 2 weeks before my scheduled procedure due to aspiration risk from delayed gastric emptying.

If you have any upcoming surgeries or procedures requiring anesthesia, TELL YOUR SURGEON AND ANESTHESIOLOGIST that you're on a GLP-1. This is critical for safety.

Closing the loop on my own question.

Update: approved on the third attempt after a peer-to-peer. Nothing about my case changed; only who was doing the talking.

Dr.AddMedPHL said:

Timing surgery and anaesthesia around surgery: my surgeon required me to stop GLP-1 agonists 2 weeks before my scheduled procedure due to aspiration…

Important PSA about surgery and anaesthesia and anesthesia: GLP-1 agonists delay gastric emptying, which increases aspiration risk during procedures requiring sedation or general anesthesia.

Current ASA guidelines recommend stopping GLP-1 agonists 2 weeks before scheduled procedures. ALWAYS tell your surgical team you're on this medication. Don't let this get overlooked.