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Obesity Surgery

, Volume 22, Issue 9, pp 1496–1506 | Cite as

Weight Loss Surgery for Mild to Moderate Obesity: A Systematic Review and Economic Evaluation

  • Joanna Picot
  • Jeremy Jones
  • Jill L. Colquitt
  • Emma Loveman
  • Andrew J. Clegg
Other

Abstract

Background

A systematic review and economic evaluation was commissioned to determine the effectiveness and cost-effectiveness of bariatric surgery for mild [class I, body mass index (BMI) 30 to 34.99] or moderate (class II, BMI 35 to 39.99) obesity.

Methods

We searched 17 electronic resources (to February 2010) and other sources. Studies meeting predefined criteria were identified, data-extracted and assessed for risk of bias using standard methodology. A model was developed to estimate cost-effectiveness.

Results

Two RCTs were included. Evidence from both indicated a statistically significant benefit from laparoscopic adjustable banding (LAGB) compared to a non-surgical comparator for weight loss and in obesity-related comorbidity. Both interventions were associated with adverse events. LAGB costs more than non-surgical management. For people with class I or II obesity and type 2 diabetes (T2D), the incremental cost-effectiveness ratio (ICER) at 2 years is £20,159, reducing to £4,969 at 5 years and £1,634 at 20 years. Resolution of T2D makes the greatest contribution to this reduction. In people with class I obesity, the ICER is £63,156 at 2 years, £17,158 at 5 years, and £13,701 at 20 years. Cost-effectiveness results are particularly sensitive to utility gain from reduction in BMI, factors associated with poorer surgical performance and diabetes health state costs.

Conclusions

Bariatric surgery appears to be a clinically effective and cost-effective intervention for people with class I or II obesity who also have T2D but is less likely to be cost-effective for people with class I obesity.

Keywords

Bariatric surgery Obesity Diabetes mellitus Systematic review Cost-effectiveness 

Notes

Conflict of Interest

All contributing authors declare that they have no conflicts of interest.

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Copyright information

© Southampton Health Technology Assessments Centre, Crown Copyright 2012

Authors and Affiliations

  1. 1.Southampton Health Technology Assessments Centre (SHTAC)University of SouthamptonSouthamptonUK

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