Adequate Multivitamin Supplementation after Roux-En-Y Gastric Bypass Results in a Decrease of National Health Care Costs: a Cost-Effectiveness Analysis

  • Jens HomanEmail author
  • Wendy Schijns
  • Ignace M. C. Janssen
  • Frits J. Berends
  • Edo O. Aarts
Original Contributions



Patients with morbid obesity undergoing metabolic surgery are prone to develop vitamin and mineral deficiencies, which may worsen in time. In order to prevent these deficiencies after metabolic surgery, all patients are advised to take daily multivitamin supplementation. The aim of the study was to assess the cost-effectiveness of specially developed multivitamins (WLS Forte®) for metabolic surgery and over-the-counter (standard) multivitamin supplementation (sMVS).


This cost-effectiveness analysis was preformed alongside an RCT for the Netherlands. Between June 2011 and March 2012, a total of 148 patients were randomized to one tablet daily of either WLS Forte® or sMVS. The patients were followed for 12 months. Data on costs within the health sector and outside the health sector were collected. The primary outcome is financial and logistic advantages, in terms of less patient visits to the outpatient department and the relevant costs to the employer due to absenteeism.


In total, 10 (14%) patients in the WLS Forte® group versus 23 (30%) patients in the sMVS group developed a deficiency. The costs for the WLS forte® supplement were €38 versus €23 for sMVS. Additional return visits and associated costs for medical staff were the largest costs, up to 43% in the sMVS group. Total costs for supplementation with sMVS were €243 versus €134 for WLS Forte®.


Preventing deficiencies with WLS Forte® seem initially more expensive than sMVS. However, treatment with WLS Forte® resulted in less vitamin and mineral deficiencies, which eventually resulted in less overall costs.


Cost-effectiveness Multivitamin supplementation Morbid obesity Roux-en-Y gastric bypass 



We would like to thank M.M. Rovers (M.D. Ph.D.) for her contribution to our work.

Funding Information

this research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector. For the initial randomized controlled trial, capsules and placebo capsules were provided free of charge.

Compliance with Ethical Standards

Conflict of Interest

IMCJ, FJB, and EOA are consults for FitForMe™, Rotterdam, the Netherlands. All the other authors have nothing to declare.

Informed Consent Statement

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Angrisani L, Santonicola A, Lovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 2018. 28:3783–3794.Google Scholar
  2. 2.
    Aarts EO, van Wageningen B, Janssen IM, et al. Prevalence of anemia and related deficiencies in the first year following laparoscopic gastric bypass for morbid obesity. J Obes. 2012;2012:193705.CrossRefGoogle Scholar
  3. 3.
    Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15(2):145–54.CrossRefGoogle Scholar
  4. 4.
    Duran de Campos C, Dalcanale L, Pajecki D, et al. Calcium intake and metabolic bone disease after eight years of Roux-en-Y gastric bypass. Obes Surg. 2008;18(4):386–90.CrossRefGoogle Scholar
  5. 5.
    Flores L, Osaba MJ, Andreu A, et al. Calcium and vitamin D supplementation after gastric bypass should be individualized to improve or avoid hyperparathyroidism. Obes Surg. 2010;20(6):738–43.CrossRefGoogle Scholar
  6. 6.
    Vargas-Ruiz AG, Hernandez-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2008;18(3):288–93.CrossRefGoogle Scholar
  7. 7.
    Dogan K, Aarts E, Koehestanie P, et al. Optimization of vitamin suppletion after roux-en-y gastric bypass surgery can lower postoperative deficiencies. Medicine (Baltimore). 2014;93(25):e169.CrossRefGoogle Scholar
  8. 8.
    Hakkaart L TS, Bouwmans CAM. Handleiding voor kostenonderzoek. Methoden en standaard kostprijzen voor economische evaluaties in de gezondheidszorg. available at: www cvz nl 2010. 2010;available from URL: Accessed Jan 2018.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryRijnstate HospitalArnhemThe Netherlands

Personalised recommendations