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.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
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.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292:1724–37.
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.
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.
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.
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.
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.
Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.
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.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.
Sowemimo OA, Yood SM, Courtney J, et al. Natural history of morbid obesity without surgical intervention. Surg Obes Relat Dis. 2007;3:73–7.
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.
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.
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.
Powers KA, Rehrig ST, Jones DB. Financial impact of obesity and bariatric surgery. Med Clin North Am. 2007;91:321–8.
National Audit Office (NAO). Tackling obesity in England, HC 220. London: The Stationery Office; 2001.
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
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.
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.
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.
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.
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.
Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999;31:S663–7.
Finkelstein EA, Ruhm CJ, Kosa KM. Economic causes and consequences of obesity. Annu Rev Public Health. 2005;26:239–57.
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.
Sturm R. The effects of obesity, smoking, and drinking on medical problems and costs. Health Aff. 2002;21:245–53.
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.
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.
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.
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.
Wolf AM, Colditz GA. The cost of obesity. The US perspective. Pharmacoecomomics. 1994;5:34–7.
Cawley J, Rizzo JA, Haas K. Occupation-specific absenteeism costs associated with obesity and morbid obesity. J Occup Environ Med. 2007;49:1317–24.
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.
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.
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.
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.
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.
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.
Fisher BL. Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding. Obes Surg. 2004;14:67–72.
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.
Encinosa WE, Bernard DM, Du D, et al. Recent improvements in bariatric surgery outcomes. Med Care. 2009;47:531–5.
De Waele BD, Lauwers M, Van Nieuwenhove Y, et al. Outpatient laparoscopic gastric banding: initial experience. Obes Surg. 2004;14:1108–10.
Montgomery KF, Watkins BM, Ahroni JH, et al. Outpatient laparoscopic adjustable gastric banding in super-obese patients. Obes Surg. 2007;17:711–6.
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.
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.
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.
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.
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.
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.
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.
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.
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