Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity
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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.
KeywordsObesity Bariatric surgery Cost-effectiveness QALY
JEL ClassificationI10 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.
- 2.Ogden, C., Carroll, M.: Prevalence of overweight, obesity, and extreme obesity among adults: United States, trends 1976–1980 through 2007–2008. In: National Center for Health Statistics, Centers for Disease Control and Prevention, Atlanta (2010)Google Scholar
- 4.McQueen, D.A., Long, M.J., Algotar, A.M., Schurman, J.R., 2nd, Bangalore, V.G.: The effect of obesity on quality-of-life improvement after total knee arthroplasty. Am. J. Orthop. (Belle Mead NJ). 36(8), E117–120, E127 (2007)Google Scholar
- 12.Mechanick, J.I., Kushner, R.F., Sugerman, H.J., Gonzalez-Campoy, J.M., Collazo-Clavell, M.L., Guven, S., Spitz, A.F., Apovian, C.M., Livingston, E.H., Brolin, R., Sarwer, D.B., Anderson, W.A., Dixon, J.: American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery Medical Guidelines for Clinical Practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Surg. Obes. Relat. Dis 4(5 Suppl), S109–S184 (2008)PubMedCrossRefGoogle Scholar
- 14.Sjostrom, L., Peltonen, M., Jacobson, P., Sjostrom, C.D., Karason, K., Wedel, H., Ahlin, S., Anveden, A., Bengtsson, C., Bergmark, G., Bouchard, C., Carlsson, B., Dahlgren, S., Karlsson, J., Lindroos, A.K., Lonroth, H., Narbro, K., Naslund, I., Olbers, T., Svensson, P.A., Carlsson, L.M.: Bariatric surgery and long-term cardiovascular events. JAMA 307(1), 56–65 (2012)PubMedCrossRefGoogle Scholar
- 15.Powers, K.A., Rehrig, S.T., Jones, D.B.: Financial impact of obesity and bariatric surgery. Med. Clin. North. Am. 91(3), 321–338, ix (2007)Google Scholar
- 18.Avenell, A., Broom, J., Brown, T.J., Poobalan, A., Aucott, L., Stearns, S.C., Smith, W.C., Jung, R.T., Campbell, M.K., Grant, A.M.: Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health. Technol. Assess. 8(21), iii–iv, 1–182 (2004)Google Scholar
- 31.Picot, J., Jones, J., Colquitt, J.L., Gospodarevskaya, E., Loveman, E., Baxter, L., Clegg, A.J.: The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health. Technol. Assess. 13(41), 1–190, 215–357, iii–iv (2009)Google Scholar
- 32.Wong, E., Wang, B., Alfonso-Cristancho, R., Flum, D., Sullivan, S., Garrison, L., Arterburn, D.: BMI trajectories among the severely obese: results from an electronic medical record population. Obesity 20, 2107–2112 (2012)Google Scholar
- 33.Arterburn, D., Ichikawa, L., Ludman, E.J., Operskalski, B., Linde, J.A., Anderson, E., Rohde, P., Jeffery, R.W., Simon, G.E.: Validity of clinical body weight measures as substitutes for missing data in a randomized trial. Obes. Res. Clin. Pract. 2(4), 277–281 (2008)PubMedCentralPubMedCrossRefGoogle Scholar
- 36.Duan, N., Manning, W.G., Morris, C.N., Newhouse, J.P.: A comparison of alternative models for the demand for medical care. J. Bus. Econ. Stat. 1(2), 115–126 (1983)Google Scholar
- 43.Lee, A.J., Morgan, C.L., Morrissey, M., Wittrup-Jensen, K.U., Kennedy-Martin, T., Currie, C.J.: Evaluation of the association between the EQ-5D (health-related utility) and BMI (obesity) in hospital-treated people with type 1 diabetes, type 2 diabetes and with no diagnosed diabetes. Diabet. Med. 22(11), 1482–1486 (2005)PubMedCrossRefGoogle Scholar