GLP-1 medications versus surgery and balloon: evaluating cost-benefit in weight loss

Abstract

This narrative review compares three prominent interventions-GLP-1 receptor agonists (e.g., semaglutide), laparoscopic sleeve gastrectomy (LSG), and intragastric balloon therapy-regarding their clinical efficacy and cost-effectiveness. Drawing on recent meta-analyses, professional guidelines, and economic modeling studies from 2023-2025, we synthesize key findings related to weight loss outcomes, comorbidity resolution, and long-term value. Bariatric surgery, particularly LSG, achieves the most substantial and durable weight loss (~20-30% of total body weight) and offers superior long-term benefits, including diabetes remission and reduced cardiovascular risk. Despite high initial costs, it is consistently found to be cost-effective or cost-saving over time, particularly in patients with diabetes. GLP-1 receptor agonists produce meaningful weight loss (~10-15%) and metabolic improvement but are associated with significant ongoing costs and potential weight regain after discontinuation, limiting long-term cost-effectiveness. Intragastric balloon therapy is less invasive and lower in immediate cost, with moderate efficacy (~10-15% weight loss), but typically results in temporary benefits and limited insurance coverage. As a standalone therapy, its cost-effectiveness is inferior to surgery, though modeling suggests economic value when used as a pre-surgical adjunct. Overall, LSG emerges as the most cost-effective intervention in severe obesity, while GLP-1 therapy’s value depends heavily on duration and pricing. Intragastric balloons may be viable for specific subpopulations or preparatory contexts. Tailoring intervention selection based on both clinical and economic parameters is essential for sustainable obesity management. Further research is warranted to refine cost-benefit assessments as new therapies and pricing models evolve.