Skip to main content
SpringerLink
Log in

Bariatric Surgery: Cost-Effectiveness and Budget Impact

Obesity Surgery volume 22, pages 646–653 (2012)Cite this article

Abstract

Bariatric surgery is to date the most effective treatment for morbid obesity and it has been proven to reduce obesity-related comorbidities and total mortality. As any medical treatment, bariatric surgery is costly and doubts about its affordability have been raised. On the other hand, bariatric surgery may reduce the direct and indirect costs of obesity and related comorbidities. The appreciation of the final balance between financial investments and savings is critical from a health economic perspective. In this paper, we try to provide a brief updated review of the most recent studies on the cost-efficacy of bariatric surgery, with particular emphasis on budget analysis. A brief overview of the economic costs of obesity will also be provided. The epidemic of obesity may cause a significant reduction in life expectancy and overwhelming direct and indirect costs for citizens and societies. Cost-efficacy analyses included in this review consistently demonstrated that the additional years of lives gained through bariatric surgery may be obtained at a reasonable and affordable cost. In groups of patients with very high obesity-related health costs, like patients with type 2 diabetes, the use of bariatric surgery required an initial economic investment, but may save money in a relatively short period of time.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  PubMed  CAS  Google Scholar 

  3. Sjöström L, Lindroos A-K, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Eng J Med. 2004;351:2683–93.

    Article  Google Scholar 

  4. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. A randomized controlled trial. JAMA. 2008;299:316–23.

    Article  PubMed  CAS  Google Scholar 

  5. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  6. MacDonald Jr KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg. 1997;1:213–20.

    Article  PubMed  Google Scholar 

  7. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240:416–23.

    Article  PubMed  Google Scholar 

  8. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.

    Article  PubMed  Google Scholar 

  9. Busetto L, Mirabelli D, Petroni ML, et al. Comparative long-term mortality after laparoscopic adjustable gastric banding versus nonsurgical controls. Surg Obes Relat Dis. 2007;3:496–502.

    Article  PubMed  Google Scholar 

  10. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.

    Article  PubMed  CAS  Google Scholar 

  11. Sowemimo OA, Yood SM, Courtney J, et al. Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis. 2007;3:73–7.

    Article  PubMed  Google Scholar 

  12. Peeters A, O’Brien PE, Laurie C, et al. Substantial intentional weight loss and mortality in the severely obese. Ann Surg. 2007;246:1028–33.

    Article  PubMed  Google Scholar 

  13. Pontiroli AE, Morabito A. Long-term prevention of mortality in morbid obesity through bariatric surgery. A systematic review and meta-analysis of trials performed with gastric banding and gastric bypass. Ann Surg. 2011;253:1–4.

    Article  Google Scholar 

  14. Finkelstein EA, Trogdon JG, Cohen JW, et al. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff. 2009;28:w822–31.

    Article  Google Scholar 

  15. Powers KA, Rehrig ST, Jones DB. Financial impact of obesity and bariatric surgery. Med Clin North Am. 2007;91:321–8.

    Article  PubMed  Google Scholar 

  16. National Audit Office (NAO). Tackling obesity in England, HC 220. London: The Stationery Office; 2001.

    Google Scholar 

  17. National Institute for Health and Clinical Excellence (NICE) Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE clinical guideline 43. Issue date: December 2006

  18. Levi J, Vinter S, Richardson L, et al. F as in fat: how obesity policies are failing in America. Issue report. Princeton: Robert Wood Johnson Foundation; 2009.

    Google Scholar 

  19. Katzmarzyk PT, Janssen I. The economic costs associated with physical inactivity and obesity in Canada: an update. Can J Appl Physiol. 2004;29:90–115.

    Article  PubMed  Google Scholar 

  20. Finkelstein EA, Derek S, Brown DS, et al. Individual and aggregate years-of-life-lost associated with overweight and obesity. Obesity. 2010;18:333–9.

    Article  PubMed  Google Scholar 

  21. Wang F, McDonald T, Bender J, et al. Association of healthcare costs with per unit body mass index increase. J Occup Environ Med. 2006;48:668–74.

    Article  PubMed  Google Scholar 

  22. Quesenberry Jr CP, Caan B, Jacobson A. Obesity, health services use, and health care costs among members of a health maintenance organization. Arch Intern Med. 1998;158:466–72.

    Article  PubMed  Google Scholar 

  23. Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999;31:S663–7.

    Article  PubMed  CAS  Google Scholar 

  24. Finkelstein EA, Ruhm CJ, Kosa KM. Economic causes and consequences of obesity. Annu Rev Public Health. 2005;26:239–57.

    Article  PubMed  Google Scholar 

  25. Trogdon JG, Finkelstein EA, Feagan CW, et al. State- and payer-specific estimates of annual medical expenditures attributable to obesity. Obesity. 2012;20(1):214–20. doi:10.1038/oby.2011.169.

    Article  PubMed  Google Scholar 

  26. Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff. 2002;21:245–53.

    Article  Google Scholar 

  27. Wadden TA, Sarwer DB, Fabricatore AN, et al. Psychosocial and behavioural status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am. 2007;91:451–69.

    Article  PubMed  Google Scholar 

  28. Finkelstein EA, Brown DS. A cost–benefit stimulation model of coverage for bariatric surgery among full-time employees. Am J Manag Care. 2005;11:641–6.

    PubMed  Google Scholar 

  29. Narbro K, Jonsson E, Larsson B, et al. Economic consequences of sick-leave and early retirement in obese Swedish women. Int J Obes. 1996;20:895–903.

    CAS  Google Scholar 

  30. Frezza EE, Wachtel MS, Ewing BT. The impact of morbid obesity on the state economy: an initial evaluation. Surg Obes Relat Dis. 2006;2:504–8.

    Article  PubMed  Google Scholar 

  31. Wolf AM, Colditz GA. The cost of obesity. The US perspective. Pharmacoecomomics. 1994;5:34–7.

    Article  CAS  Google Scholar 

  32. Cawley J, Rizzo JA, Haas K. Occupation-specific absenteeism costs associated with obesity and morbid obesity. J Occup Environ Med. 2007;49:1317–24.

    Article  PubMed  Google Scholar 

  33. Sjöström L, Larsson B, Backmann L, et al. Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state. Int J Obes. 1992;16:465–79.

    Google Scholar 

  34. Salem L, Devlin A, Sullivan S. Cost-effectiveness of laparoscopic gastric bypass, adjustable gastric banding, and non-operative weight-loss interventions. Surg Obes Relat Dis. 2008;4:26–32.

    Article  PubMed  Google Scholar 

  35. Campbell J, McGarry L, Shikora SA, et al. Cost-effectiveness of laparoscopic gastric banding and bypass in the treatment of morbid obesity. Am J Manag Care. 2010;16:e174–87.

    PubMed  Google Scholar 

  36. Clegg A, Colquitt J, Sidhu M, et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes. 2003;27:1167–77.

    Article  CAS  Google Scholar 

  37. Picot J, Jones J, Colquitt JL, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(1–190):215–357.

    Google Scholar 

  38. van Mastrigt GA, van Dielen FM, Severens JL, et al. One-year cost-effectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus Lap-Band. Obes Surg. 2006;16:75–84.

    Article  PubMed  Google Scholar 

  39. Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obes Surg. 2004;14:67–72.

    Article  PubMed  Google Scholar 

  40. Nguyen N, Slone J, Nguyen XT, et al. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity. Ann Surg. 2009;250:631–41.

    PubMed  Google Scholar 

  41. Encinosa WE, Bernard DM, Du D, et al. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47:531–5.

    Article  PubMed  Google Scholar 

  42. De Waele BD, Lauwers M, Van Nieuwenhove Y, et al. Outpatient laparoscopic gastric banding: initial experience. Obes Surg. 2004;14:1108–10.

    Article  PubMed  Google Scholar 

  43. Montgomery KF, Watkins BM, Ahroni JH, et al. Outpatient laparoscopic adjustable gastric banding in super-obese patients. Obes Surg. 2007;17:711–6.

    Article  PubMed  Google Scholar 

  44. Watkins BM, Ahroni JH, Michaelson R, et al. Laparoscopic adjustable gastric banding in an ambulatory surgery center. Surg Obes Relat Dis. 2008;4:S56–62.

    Article  PubMed  Google Scholar 

  45. Wasowicz-Kemps DK, Bliemer B, Boom FA, et al. Laparoscopic gastric banding for morbid obesity: outpatient procedure versus overnight stay. Surg Endosc. 2006;20:1233–7.

    Article  PubMed  CAS  Google Scholar 

  46. Segal JB, Clark JM, Shore AD, et al. Prompt reduction in use of medications for comorbid conditions after bariatric surgery. Obes Surg. 2009;19:1646–56.

    Article  PubMed  Google Scholar 

  47. Ackroyd R, Mouiel J, Chevallier J-M, et al. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16:1488–503.

    Article  PubMed  Google Scholar 

  48. Anselmino M, Bammer T, Fernandez JM, et al. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries (II). Obes Surg. 2009;19:1542–9.

    Article  PubMed  Google Scholar 

  49. Keating CL, Dixon JB, Moodie ML, et al. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32:580–4.

    Article  PubMed  Google Scholar 

  50. Peeters A, Barendregt JJ, Willekens F, et al. Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003;138:24–32.

    PubMed  Google Scholar 

Download references

Conflicts of Interest

Lorenzo Terranova declares to have received an institutional grant and direct payments for board membership from Allergan. Luca Busetto, Annarita Vestri, and Marco Antonio Zappa declare to have received an institutional grant and direct payments for board membership, service on speaker’s bureau, and travel reimbursement from Allergan.

Author information

Authors and Affiliations

  1. Federazione Italiana Aziende Sanitarie e Ospedaliere (FIASO), Scuola di Specializzazione in Statistica Sanitaria, Università di Roma “La Sapienza”, Rome, Italy

    Lorenzo Terranova

  2. Unità Bariatrica, Dipartimento di Medicina, Università degli Studi di Padova, Padua, Italy

    Luca Busetto

  3. Dipartimento di Sanità Pubblica e Malattie Infettive, Facoltà di Farmacia e Medicina, Università di Roma “La Sapienza”, Rome, Italy

    Annarita Vestri

  4. Unità Operativa Complessa Chirurgia Generale, Ospedale “Sacra Famiglia” Fatebenefratelli, Erba, Italy

    Marco Antonio Zappa

  5. Clinica Medica I, Policlinico Universitario, Via Giustiniani 2, 35128, Padua, Italy

    Luca Busetto

Authors
  1. Lorenzo Terranova
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luca Busetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annarita Vestri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Antonio Zappa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luca Busetto.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Terranova, L., Busetto, L., Vestri, A. et al. Bariatric Surgery: Cost-Effectiveness and Budget Impact. OBES SURG 22, 646–653 (2012). https://doi.org/10.1007/s11695-012-0608-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-012-0608-1

Keywords

search

Navigation