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Cost-Effectiveness Analysis of Bariatric Surgery for Morbid Obesity

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Abstract

Background

In the USA, three types of bariatric surgeries are widely performed, including laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic adjustable gastric banding (LAGB). However, few economic evaluations of bariatric surgery are published. There is also scarcity of studies focusing on the LSG alone. Therefore, this study is evaluating the cost-effectiveness of bariatric surgery using LRYGB, LAGB, and LSG as treatment for morbid obesity.

Methods

A microsimulation model was developed over a lifetime horizon to simulate weight change, health consequences, and costs of bariatric surgery for morbid obesity. US health care prospective was used. A model was propagated based on a report from the first report of the American College of Surgeons. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained were used in the model. Model parameters were estimated from publicly available databases and published literature.

Results

LRYGB was cost-effective with higher QALYs (17.07) and cost ($138,632) than LSG (16.56 QALYs; $138,925), LAGB (16.10 QALYs; $135,923), and no surgery (15.17 QALYs; $128,284). Sensitivity analysis showed initial cost of surgery and weight regain assumption were very sensitive to the variation in overall model parameters. Across patient groups, LRYGB remained the optimal bariatric technique, except that with morbid obesity 1 (BMI 35–39.9 kg/m2) patients, LSG was the optimal choice.

Conclusion

LRYGB is the optimal bariatric technique, being the most cost-effective compared to LSG, LAGB, and no surgery options for most subgroups. However, LSG was the most cost-effective choice when initial BMI ranged between 35 and 39.9 kg/m2.

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Authors and Affiliations

  1. Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, 02115, USA

    Adnan Alsumali & Tewodros Eguale

  2. Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Tewodros Eguale

  3. Department of Surgery, George Washington University, Washington, DC, USA

    Sigrid Bairdain

  4. Department of Clinical Research Center, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Mihail Samnaliev

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  1. Adnan Alsumali
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  2. Tewodros Eguale
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  4. Mihail Samnaliev
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Correspondence to Adnan Alsumali.

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The authors declare that they have no competing interests.

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Alsumali, A., Eguale, T., Bairdain, S. et al. Cost-Effectiveness Analysis of Bariatric Surgery for Morbid Obesity. OBES SURG 28, 2203–2214 (2018). https://doi.org/10.1007/s11695-017-3100-0

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