Cost–utility analysis of bariatric surgery

Borisenko, O.; Lukyanov, Vasily; Ahmed, Amna

doi:10.1002/bjs.10857

Cited by 41 publications

(45 citation statements)

References 39 publications

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“…Obesity is a common metabolic disease that is increasing worldwide 1 . Bariatric surgery treats obesity and related metabolic syndromes, including obstructive sleep apnoea, diabetes, gastro-oesophageal reflux disease and orthopaedic physical dysfunction 2,3 , and has been found to be associated with reduced mean costs to the health service 4 . Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy are the two most commonly used procedures 5,6 .…”

Section: Introductionmentioning

confidence: 99%

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Ikeda

Aida

Yoshida

et al. 2020

British Journal of Surgery

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Background: Laparoscopic sleeve gastrectomy (LSG) is a well established treatment for severe obesity and type 2 diabetes. Although the gut microbiota is linked to the efficacy of LSG, the underlying mechanisms remain elusive. The effect of LSG for morbid obesity on the gut microbiota and bile acids was assessed here. Methods: Severely obese subjects who were candidates for LSG were included and followed until 6 months after surgery. The composition and abundance of the microbiota and bile acids in faeces were assessed by 16S ribosomal RNA sequencing, quantitative PCR and liquid chromatography-mass spectrometry. Results: In total, 28 patients with a mean(s.d.) BMI of 44⋅2(6⋅6) kg/m 2 were enrolled. These patients had achieved excess weight loss of 53⋅2(19⋅0) per cent and showed improvement in metabolic diseases by 6 months after LSG, accompanied by an alteration in the faecal microbial community. The increase in-diversity and abundance of specific taxa, such as Rikenellaceae and Christensenellaceae, was strongly associated with reduced faecal bile acid levels. These changes had a significant positive association with excess weight loss and metabolic alterations. However, the total number of faecal bacteria was lower in patients before (mean(s.d.) 10⋅26(0⋅36) log 10 cells per g faeces) and after (10⋅39(0⋅29) log 10 cells per g faeces) operation than in healthy subjects (10⋅83(0⋅27) log 10 cells per g faeces). Conclusion: LSG is associated with a reduction in faecal bile acids and greater abundance of specific bacterial taxa and-diversity that may contribute to the metabolic changes.

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Section: Introductionmentioning

confidence: 99%

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Ikeda

Aida

Yoshida

et al. 2020

British Journal of Surgery

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“…Obesity is increasing worldwide, including patients suffering from psychiatric disorders. The most effective treatment for obesity is bariatric surgery, which has been proven to be safe [1] and cost-effective [2].…”

Section: Introductionmentioning

confidence: 99%

Risk of Delayed Discharge and Reoperation of Gastric Bypass Patients with Psychiatric Comorbidity—a Nationwide Cohort Study

et al. 2020

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Background Gastric bypass (GBP) surgery is considered a safe and effective treatment for obesity. However, there is uncertainty regarding the impact of preexisting psychiatric comorbidity on GBP complications. We have investigated whether a psychiatric diagnosis before GBP surgery is associated with delayed discharge (the odds of being in the 90th percentile of length of stay) and rate of reoperation in a nationwide Swedish cohort. Methods Patients undergoing GBP surgery during 2008–2012 were identified and followed up through the National Patient Register and the Prescribed Drug Register. Logistic regression models were fitted to the studied outcomes. Results Among the 22,539 patients identified, a prior diagnosis of bipolar disorder, schizophrenia, depression, neurotic disorders, ADHD (attention deficit hyperactivity disorder), substance use disorder, eating disorder, personality disorder, or self-harm since 1997 (n = 9480) was found to be associated with delayed discharge after GBP surgery (odds ratio [OR] = 1.47, confidence interval [CI] 1.34–1.62), especially in patients with psychiatric hospitalization exceeding 1 week in the 2 years preceding GBP surgery (OR = 2.06, CI 1.30–3.28), compared with those not hospitalized within psychiatry. Likewise, patients with a prior psychiatric diagnosis were more likely to be reoperated within 30 days (OR = 1.25, CI 1.11–1.41), with twice the likelihood OR 2.23 (CI 1.26–3.92) for patients with psychiatric hospitalization of up to a week in the 2 years preceding GBP surgery, compared with patients who had not been hospitalized within psychiatry. Conclusions A psychiatric diagnosis before GBP surgery was associated with delayed discharge and increased likelihood of reoperation within 30 days. Patients with a prior psychiatric diagnosis may, therefore, need additional attention and support.

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“…After removing duplicate papers 1096 studies remained for title and abstract screening, with 63 studies included for full‐text review. Of these, 24 partial and full health economic evaluation studies were included in the updated systematic review . These studies were also assessed against the eligibility criteria for quantitative meta‐analyses together with the n = 77 eligible health economic evaluations from our previous systematic review (low part of Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, when costs were qualitatively synthesised, the review found heterogeneous results. For instance, across the depth and breadth of the comprehensive review's 77 included studies, some of the studies showed that the average total costs were higher in the bariatric group, whilst others revealed that the control group had higher costs . A narrative synthesis of the before and after bariatric surgery studies showed that total costs were higher after surgery in the shorter term …”

Section: Introductionmentioning

confidence: 99%

Bariatric surgery is a cost‐saving treatment for obesity—A comprehensive meta‐analysis and updated systematic review of health economic evaluations of bariatric surgery

et al. 2019

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Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.

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Cost–utility analysis of bariatric surgery

Abstract: Currently used surgical methods were found to be cost saving over the lifetime of individuals treated in England.

Cited by 41 publications

References 39 publications

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Alteration in faecal bile acids, gut microbial composition and diversity after laparoscopic sleeve gastrectomy

Risk of Delayed Discharge and Reoperation of Gastric Bypass Patients with Psychiatric Comorbidity—a Nationwide Cohort Study

Bariatric surgery is a cost‐saving treatment for obesity—A comprehensive meta‐analysis and updated systematic review of health economic evaluations of bariatric surgery

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