The European Journal of Health Economics

, Volume 15, Issue 3, pp 253–263 | Cite as

Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity

  • Bruce C. M. Wang
  • Edwin S. Wong
  • Rafael Alfonso-Cristancho
  • Hao He
  • David R. Flum
  • David E. Arterburn
  • Louis P. Garrison
  • Sean D. Sullivan
Original Paper



One-third of Americans are obese and an increasing number opt for bariatric surgery. This study estimates the cost-effectiveness of common bariatric surgical procedures from a healthcare system perspective.


We evaluated the three most common bariatric surgical procedures in the US: laparoscopic gastric bypass (LRYGB), conventional (open) Roux-en-Y gastric bypass (ORYGB), and laparoscopic adjustable gastric banding (LAGB) compared to no surgery. The reference case was defined as a 53-year old female with body mass index (BMI) of 44 kg/m2. We developed a two-part model using a deterministic approach for the first 5-year period post-surgery and separate empirical forecasts for the natural history of BMI, costs and outcomes in the remaining years. We used a combination of datasets including Medicare and MarketScan® together with estimates from the literature to populate the model.


Bariatric surgery produced additional life expectancy (80–81 years) compared to no surgery (78 years). The incremental cost-effectiveness ratios (ICERs) of the surgical procedures were US $6,600 per quality-adjusted life expectancy (QALY) gained for LRYGB, US $6,200 for LAGB, and US $17,300 for ORYGB (3 % discount rate for cost and QALYs). ICERs varied according to choice of BMI forecasting method and clinically plausible variation in parameter estimates. In most scenarios, the ICER did not exceed a threshold of US $50,000 per QALY gained.


Obesity Bariatric surgery Cost-effectiveness QALY 

JEL Classification

I10 D61 D81 



The Bariatric Outcomes and Obesity Modeling (BOOM) Project is a multidisciplinary research collaboration investigating obesity health services. Collaborators include: Franklin Skip Carr and Larry Belenke (Ventura Healthcare Systems LLC); David Flum MD MPH (co-PI), Andrew Wright MD, Rebecca Petersen MD, Steve Kwon, MD, Allison Devlin Rhodes MS, Kara E. MacLeod MPH, MA, Rebecca Gaston Symons, MPH, Andy Louie, Erin Machinchick, Katrina Golub MPH, Hao He PhD (Surgical Outcomes Research Center, University of Washington); Sean D. Sullivan PhD (co-PI), Louis Garrison PhD, Rafael Alfonso MD, MS, Bruce Wang PhD, Edwin Wong PhD, (Pharmaceutical Outcomes Research and Policy Program, University of Washington); David Arterburn MD, MPH (Group Health Research Institute, Group Health); and Louis Martin MD MS (Samaritan Physicians). This research was supported by Department of Defense (DoD) Agreement FA 7014-08-0002 and National Institutes of Digestive Disease and Kidney (NIDDK) 1R21DK069677. Its content is solely the responsibility of the authors and does not necessarily represent the official views of the DoD, NIDDK, the University of Washington, the Department of Veterans Affairs and Group Health Research Institute. The DoD and NIDDK did not participate in design and conduct of the study, collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript.

Supplementary material

10198_2013_472_MOESM1_ESM.docx (98 kb)
Supplementary material 1 (DOCX 97 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Bruce C. M. Wang
    • 1
  • Edwin S. Wong
    • 1
    • 2
  • Rafael Alfonso-Cristancho
    • 1
    • 3
  • Hao He
    • 3
  • David R. Flum
    • 3
  • David E. Arterburn
    • 4
  • Louis P. Garrison
    • 1
  • Sean D. Sullivan
    • 1
  1. 1.Pharmaceutical Outcomes Research and Policy ProgramUniversity of WashingtonSeattleUSA
  2. 2.Northwest Center for Outcomes Research in Older Adults, VA Puget SoundSeattleUSA
  3. 3.Surgical Outcomes Research CenterUniversity of WashingtonSeattleUSA
  4. 4.Group Health Research InstituteSeattleUSA

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