Abstract
Background
In South Korea, the number of severely obese patients has increased. An economic study comparing bariatric surgery with nonsurgical interventions has not been published for Asia.
Objectives
This study was conducted to evaluate the cost effectiveness of bariatric surgery as compared to nonsurgical interventions for severe obese Korean people.
Methods
We used the Markov model to compare the lifetime expected costs and quality-adjusted life years (QALYs) between bariatric surgery and nonsurgical interventions from Korean Healthcare system perspectives. Our target cohort consisted of severe obese people defined as having a body mass index of 30–<40 kg/m2 in South Korea. The starting age of the cohort was 30 years old, and the cycle length was 1 year. Nonsurgical interventions included a physician visit, exercise, diet, and pharmacotherapy. A discount of 5 % was applied in cost and QALY. The incremental cost-effectiveness ratio (ICER) of bariatric surgery compared to nonsurgery interventions was calculated.
Results
The cost-utility analysis study indicated that bariatric surgery had US$1,522 incremental costs and 0.86 incremental QALYs as compared to nonsurgical interventions. Through the base case analysis, ICER was US$1,771/QALY. The sensitivity analyses were performed using a variety of assumptions, and the robustness of the study results was also demonstrated.
Conclusion
The study indicated that bariatric surgery was a cost-effective alternative to nonsurgical interventions over a lifetime, providing substantial lifetime benefits for severely obese Korean people.
Similar content being viewed by others
References
Korean National Health and Nutritional Examination Survey IV 2007–2009. Korean Ministry of Health and Welfare Affairs. 2010.
Obesity guidance in the prevention, identification, assessment and management of overweight and obesity in adults and children. National Institute for Health and Clinical Excellence. 2006.
Management of obesity, 2010 Recommendation. Endocrinol Metab. 2010;25:301–304.
Ramachandran A, Snehalatha C, Viswanathan V, et al. Risk of noninsulin dependent diabetes mellitus conferred by obesity and central adiposity in different ethnic groups: a comparative analysis between Asian Indians, Mexican Americans and Whites. Diabetes Res Clin Prac. 1997;36:121–5.
Kang JH, Jeong BG, Cho YG, et al. Socioeconomic costs of overweight and obesity in Korean Adults. J Korean Med Sci. 2011;26(12):1533–40.
Freedman DS. Obesity—United States, 1988–2008. MMWR Surveill Summ. 2011;60(01):73–7.
Gastrointestinal surgery for severe obesity Reference NIH conference. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–961.
Metabolic & bariatric surgery (fact sheet). American Society for Metabolic and Bariatric Surgery. 2011. http://www.asbs.org/Newsite07/media/asmbs_fs_surgery.pdf. Accessed 21 Nov 2012.
Lee SK. The current status of bariatric surgery in South Korea. Korean Society for the study of obesity 33th conference. Seoul, 2010.
Lomanto D, Lee WJ, Goel R, et al. Bariatric surgery in Asia in the last 5 years (2005–2009). Obes Surg. 2012;22(3):502–6.
Lee WJ, Wang W. Bariatric surgery: Asia-Pacific perspective. Obes Surg. 2005;15(6):751–7.
Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost—the clinical effectiveness and costeffectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technology Assessment 2009;13(41).
Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113(6):491–8.
Salem L, Devlin A, Sullivan SD, et al. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg Obes Relat Dis. 2008;4(1):26–32.
Sjöström L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.
Jeong BG, Moon OR, Kim NS, et al. Socioeconomic costs of obesity for Korean adults. Korean J Prev Med. 2002;35(1):1–12.
Heo YS, Kwon JW, Lee HJ, et al. The clinical effectiveness and economic analysis of bariatric surgery for severe obesity. National Evidence-based Collaborating Agency. 2011.
Petrie D, Doran C, Shakeshaft A, et al. The relationship between alcohol consumption and self-reported health status using the EQ5D: evidence from rural Australia. Soc Sci Med. 2008;67(11):1717–26.
Sullivan PW, Ghushchyan V. Preference-Based EQ-5D index scores for chronic conditions in the United States. Med Decis Making. 2006;26(4):410–20.
The EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.
Hurst NP, Kind P, Ruta D, et al. Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol. 1997;36(5):551–9.
Lee YK, Nam HS, Chuang LH, et al. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value in Health. 2009;12(8):1187–93.
Complete Life Table 2010. Korean Statistical Office. 2010. Available at: http://kostat.go.kr Accessed 15 Sept 2012.
Korean national health insurance statistics. Health Insurance Review and Assessment. 2011.
Korean Statistical Information Service, Consumer Price Index in Healthcare. 2011. http://kosis.kr. Accessed 21 Nov 2012.
The guideline of Pharmacoeconomics in South Korea. Health Insurance Review and Assessment. 2011.
Hakim Z, Wolf A, Garrison LP. Estimating the effect of changes in body mass index on health state preferences. PharmacoEconomics. 2002;20(6):393–404.
Choosing interventions that are cost effective (WHO-CHOICE). World Health Organization. http://www.who.int/choice/costs/CER_thresholds/en/index.html. Accessed 21 Nov 2011
Ahn JH, Kim YH, Shin SJ, et al. Research on methodologies for evidence based healthcare decision making process in Korea. National Evidence-based Collaborating Agency. 2010.
Ackroyd R, Mouiel J, Chevallier JM, et al. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503.
Mäklin S, Malmivaara A, Linna M, et al. Cost-utility of bariatric surgery for morbid obesity in Finland. Br J Surg. 2011;98(10):1422–9.
Drummond MF. Comparing cost-effectiveness across countries: the model of acid-related disease. PharmacoEconomics. 1994;5:60–7.
Mark W. Stanton MA. The high concentration of U.S. health care expenditures. Agency for Healthcare Research and Quality Advancing Excellence in Health Care 2006;19.
Galani C, Al M, Schneider H, et al. Uncertainty in decision-making: value of additional information in the cost-effectiveness of lifestyle intervention in overweight and obese people. Value Health. 2008;11(3):424–34.
Trueman P, Haynes SM, Felicity LG, et al. Long-term cost-effectiveness of weight management in primary care. Int J Clin Pract. 2010;64(6):775–83.
Kwon JW, Song YM, Sung J, et al. Varying patterns of BMI increase in sex and birth cohorts of Korean adults. Obesity (Silver Spring). 2007;15(2):277–82.
Acknowledgments
This study was completed as part of the health technology assessment report (project no. NA2011-003) funded by the NECA in Korea. The results of this project underwent the appraisal process involving orthopedist, family medicine specialists, methodologists, and governmental officials. No other sources of funding were used to assist in the preparation of this article. Hyun Jin Song, Jin Won Kwon, Yong Jin Kim, Sung-Hee Oh, Yoonseok Heo, and Sang-Moon Han have no conflicts of interest that are directly relevant to the content of this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
H.J. Song and J.W. Kwon contributed equally to this work.
Rights and permissions
About this article
Cite this article
Song, H.J., Kwon, J.W., Kim, Y.J. et al. Bariatric Surgery for the Treatment of Severely Obese Patients in South Korea—Is it Cost Effective?. OBES SURG 23, 2058–2067 (2013). https://doi.org/10.1007/s11695-013-0971-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-013-0971-6