The value of metabolic surgery for patients with obesity and type 2 diabetes in Romania

Gábor Kovács¹László Lorenzovici^2,3*Cătălina Poiană⁴Adriana Florinela Catoi⁵Ciprian Duta⁶Daniel Vasile Timofte⁷Marius Florin Coros⁸Sándor Siménfalvi⁹Szabolcs Farkas- Ráduly⁹Tamás Török⁹Andrea Timea Jakab⁹Andrea Kacsó¹⁰László Nagy⁹László Imre⁹Dávid Nagy¹Catalin Andu Copaescu¹¹Bogdan Cristian Pana¹²

• ¹Syreon Research Institute, Budapest, Hungary
• ²Syreon Research Romania, Tirgu Mures, Romania
• ³Babeş-Bolyai University, Department of Economic Studies and Business Management, Cluj Napoca, Romania
• ⁴Institutul Național de Endoscrinologie C.I.Parhon, Bucharest, Romania
• ⁵"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
• ⁶University of Medicine and Pharmacy "V. Babes", Timisoara, Romania
• ⁷Grigore T Popa University of Medicine and Pharmacy, Iasi, Romania
• ⁸G.E. Palade UMPhST of Targu Mures, Targu Mures, Romania
• ⁹Syreon Research Romania, Targu Mures, Romania
• ¹⁰Medicode SRL, Targu Mures, Romania
• ¹¹Ponderas Academic Hospital, Bucharest, Romania
• ¹²University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania

Abstract Background: Metabolic surgery is a well-established intervention for managing severe obesity and type 2 diabetes, offering significant long-term health benefits. In Europe, procedures such as sleeve gastrectomy and Roux-en-Y gastric bypass have been shown to improve glycemic control, reduce obesity-related comorbidities, and enhance quality of life. Given the high prevalence of obesity in Romania, evaluating the cost-effectiveness of these surgical interventions is crucial for potential public funding inclusion. Methods: We adapted a Central European type 2 diabetes – metabolic surgery cost-utility model using Romanian epidemiological and healthcare cost data to assess the cost-effectiveness of weight-loss surgery. The model incorporated three Body Mass Index strata (30-34.9, 35-39.9, ≥40 kg/m²) and tracked outcomes over a lifetime horizon. Cost and quality-adjusted life years were evaluated for sleeve gastrectomy and Roux-en-Y gastric bypass using two costing methodologies: Diagnosis-Related Group-based reimbursement and micro-costing analysis. Scenario analyses, including threshold analysis, were conducted to validate model robustness. Results: Obesity surgery was found to be a dominant strategy, yielding both cost savings and improved health outcomes across all Body Mass Index categories. The intervention led to increased life expectancy, reduced diabetes-related complications, and a significant reduction in healthcare costs. Even under conservative cost assumptions, the surgery remained cost-effective, with an Incremental Cost-Effectiveness Ratio (ICER) well within European funding thresholds. Conclusions: The results support the inclusion of metabolic surgery in Romania's public healthcare system. Expanding access could reduce long-term healthcare expenditures while improving the quality of life for individuals with obesity and type 2 diabetes.