Cost-effectiveness analysis: GLP-1 agonists vs bariatric surgery (ICER 2026) — looking for input

amsterdam_pete said:

Denials are usually procedural rather than clinical, and the order that works reflects that.

This is where I part company with the consensus forming above. Guidance here is not settled and varies by institution, so quoting one society's interval as the rule is misleading. The invariant part is disclosure, not the number of days.

Worth separating that from cost and coverage, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Ask again with the specifics and you will get a better answer than this one.

SkepticalSean said:

I have a procedure booked and the pre-op paperwork asked about GLP-1 medication in a way that suggested somebody had recently been caught out.

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 48 hours for daily formulations before scheduled procedures. ALWAYS tell your surgical team you're on this medication. Don't let this get overlooked.

Dr.ReproEndo said:

Guidance here is not settled and varies by institution, so quoting one society's interval as the rule is misleading.

Dr.ReproEndo 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 RunnerRach — 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?

OP back with an update, since a thread like this is useless without one.

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