Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions

Abstract

Setting-Laparoscopic adjustable gastric banding (LAGB) and Laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures. While both procedures likely reduce healthcare expenditures related to the resolution of comorbid conditions, they have different rates of perioperative risks and differential rates of associated weight loss.Objective-We designed a model to evaluate the incremental cost-effectiveness (ICER) of these procedures compared to non-operative weight loss interventions and to each other.Methods-Deterministic, payer-perspective model comparing the lifetime expected costs and outcomes of LAGB, LRYGB and non-surgical treatment. The major endpoints were survival, health related quality of life and weight loss. Life expectancy and lifetime medical costs were calculated across age, sex and body mass index (BMI) strata using previously published data.Results-For both men and women LRYGB and LAGB were cost-effective at less than $25,000/ QALY even when evaluating the full range of baseline BMI and estimates of adverse outcomes, weight loss and costs. For base-case scenarios in men (age 35, BMI 40) the ICER was $11,604 per QALY for LAGB, compared to $18,543 per QALY for LRYGB. For base-case scenarios in women (age 35, BMI 40) the ICER was $8,878 per QALY for LAGB, compared to $14,680 per QALY for LRYGB.Conclusions-Modeled cost-effectiveness analysis showed that both operative interventions for morbid obesity, LAGB and RYGB, were cost-effective at less than $25,000, and LAGB was more cost-effective than RYGB for all the base-case scenarios.

Bariatric Surgery: A Systematic Review of the Clinical and Economic Evidence

“…1; Table 4) [40][41][42][43][44][45][46][47][48][49][50][51][52] . From the payer perspective, the long-term (10 years to lifetime) cost-utility of surgery compared with non-surgical management appears attractive, with incremental cost-utility ratios (ICURs) ranging from $1,000 to $40,000 per quality-adjusted life-year (QALY; 2009 USD) ( Table 4) [40][41][42]44,45,47 . While cost-effectiveness studies comparing between alternate surgical approaches were identified, the current evidence base did not allow for definitive conclusions regarding the relative cost-effectiveness between different procedures.…”

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

“…Two systematic reviews 51,143 of economic analyses of surgical interventions and five original economic evaluations [138][139][140][141][142] that met the inclusion/exclusion criteria described in Chapter 3, Inclusion criteria were identified from the full reports (listed below). The reasons for excluding 29 studies after examination of the full papers can be seen in Appendix 17.…”

“…The only other study conducted from the societal (the USA) perspective is Jensen and Flum. 141 This and two other studies [140][141][142] use the same published US clinical, epidemiological and economic data. 144 Only one study, by Ackroyd and colleagues, 138 used UK data along with data from Germany and France.…”

“…with BMI more than 35, but less than 40) with significant comorbidities is also analysed. The definition of the obese population here is consistent with the definition in the NICE Guidelines 9 and with the general criteria of eligibility for bariatric surgery, as used in the cost-effectiveness studies [138][139][140][141][142] presented below. The obese population here is therefore defined according to narrower criteria than those used for clinical effectiveness (see Chapter 3, Inclusion criteria).…”

Operational cost of obesity surgery in Turkey

“…On the other hand, it was reported that obesity surgery is more costly than non-surgical treatment options. [31][32][33][34][35] In spite of the increased cost, obesity surgery serves better clinical outcomes than non-surgical treatment options and is also reported cost effective. [36] SGK reimburses the obesity surgery with a fixed amount of 4500, 3100 and 2250 Turkish liras for by-pass, sleeve and banding surgeries, respectively.…”