Advertisement

Cost-effectiveness of Bariatric Surgery for People with Morbid Obesity in South Korea

  • Sena An
  • Hae-Young Park
  • Sung-Hee Oh
  • Yoonseok Heo
  • Susan Park
  • Soo Min Jeon
  • Jin-Won KwonEmail author
Original Contributions
  • 70 Downloads

Abstract

Objective

This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity.

Methods

The target cohort was people with morbid obesity, defined as BMI of ≥ 35 kg/m2, or obese people with BMI of 30–34.9 kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20 years, a cycle length of 1 year, a time horizon of 80 years, and a 5% discount rate were applied for the base case from the healthcare system perspective.

Results

In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0–37.4 kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS.

Conclusion

BS at BMI of > 30 kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.

Keywords

Cost-utility analysis Morbid obesity Bariatric surgery 

Notes

Acknowledgments

We thank the Health Insurance Review and Assessment Service (HIRA-NPS) for providing data for this study.

Funding

This study was funded by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number HC15C1322) and the Korea National Research Foundation (grant number NRF-2018R1D1A3B07047356).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

The study was approved by the IRB of the Kyungpook National University (KNU 2016–0007). In addition, prospective clinical trials for the source data in this study were approved by the Institutional Review Board (IRB) of their respective centers (the approval number of IRB at principal investigator center: INHAUH 2016-06-015).

Informed Consent

The NHIS-HEALS database was retrospectively established in an anonymous format, and the informed consent requirement for this study was waived, and informed consent was obtained from all individual participants included in the prospective clinical trial used for source data in this study.

References

  1. 1.
    Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks: World Health Organization; 2009.Google Scholar
  2. 2.
    Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl 2):7–12.CrossRefGoogle Scholar
  4. 4.
    Xu H, Cupples LA, Stokes A, et al. Association of Obesity with mortality over 24 years of weight history: findings from the Framingham Heart Study. JAMA Netw Open. 2018;1(7):e184587.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Wang J, Thornton JC, Russell M, et al. Asians have lower body mass index (BMI) but higher percent body fat than do whites: comparisons of anthropometric measurements. Am J Clin Nutr. 1994;60(1):23–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Gallagher D, Heymsfield SB, Heo M, et al. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694–701.CrossRefGoogle Scholar
  7. 7.
    Deurenberg-Yap M, Yian TB, Kai CS, et al. Manifestation of cardiovascular risk factors at low levels of body mass index and waist-to-hip ratio in Singaporean Chinese. Asia Pac J Clin Nutr. 1999;8(3):177–83.CrossRefPubMedGoogle Scholar
  8. 8.
    Pacific WHOROftW. The Asia-pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.Google Scholar
  9. 9.
    Collaboration NCDRF. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128.9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42.CrossRefGoogle Scholar
  10. 10.
    Shin HY, Kang HT. Recent trends in the prevalence of underweight, overweight, and obesity in Korean adults: the Korean National Health and Nutrition Examination Survey from 1998 to 2014. J Epidemiol. 2017;27(9):413–9.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Park S, Pi S, Hwang J, et al. Effects of initial body mass index and weight change on all-cause mortality: a 10-year cohort study in Korea. Asia Pac J Public Health. 2018;30(3):217–26.CrossRefPubMedGoogle Scholar
  12. 12.
    Jaacks LM, Vandevijvere S, Pan A, et al. The obesity transition: stages of the global epidemic. Lancet Diabetes Endocrinol. 2019;7(3):231–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Chung W, Lim SJ, Lee S, et al. Gender-specific interactions between education and income in relation to obesity: a cross-sectional analysis of the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V). BMJ Open. 2017;7(12):e014276.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts. 2008;1(1):52–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;184(6B):9S–16S.CrossRefPubMedGoogle Scholar
  16. 16.
    Cheng J, Gao J, Shuai X, et al. The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2016;7(26):39216–30.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Avenell A, Robertson C, Skea Z, et al. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess. 2018;22(68):1–246.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Alsumali A, Al-Hawag A, Samnaliev M, et al. Systematic assessment of decision analytic models for the cost-effectiveness of bariatric surgery for morbid obesity. Surg Obes Relat Dis. 2018;14(7):1041–59.CrossRefPubMedGoogle Scholar
  20. 20.
    Ohta M, Seki Y, Wong SK, et al. Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS 2018 survey. Obes Surg. 2019;29(2):534–41.CrossRefPubMedGoogle Scholar
  21. 21.
    Gaeun Kim SJ, Choi Y-B, Hur Y, et al. Is surgery necessary for morbid obesity patient? NECA round-table conference consensus statement. Korean J Obes. 2013;22(1):7–12.CrossRefGoogle Scholar
  22. 22.
    Song HJ, Kwon JW, Kim YJ, et al. Bariatric surgery for the treatment of severely obese patients in South Korea--is it cost-effective? Obes Surg. 2013;23(12):2058–67.CrossRefPubMedGoogle Scholar
  23. 23.
    Comparative study in morbidity obese patient with surgical and medical treatments: effectiveness, safety and cost-effectiveness R&D Report. Korean Ministry of Health and Welfare Affairs. Korea Health Industry Development Institute.; Available from: https://www.khidi.or.kr/kps/researchInfo/list?menuId=MENU02230&searchContinuStYear=&searchSprcRsrhInttNm=&searchFlnmKrn=&searchGwrd=&searchPjtMngmNo=HC15C1322&searchPjtNm=#.
  24. 24.
    Korean Ministry of Health and Welfare Affairs. Korea Centers for Disease Control. Korean National Health and Nutritional Examination Survey (2007-2015). Available from: https://knhanes.cdc.go.kr/knhanes/main.do.
  25. 25.
    Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefPubMedGoogle Scholar
  26. 26.
    Song HJ, Hwang J, Pi S, et al. The impact of obesity and overweight on medical expenditures and disease incidence in Korea from 2002 to 2013. PLoS One. 2018;13(5):e0197057.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Seong SC, Kim YY, Park SK, et al. Cohort profile: the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) in Korea. BMJ Open. 2017;7(9):e016640.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Statistics Korea (2016). Available from: http://kostat.go.kr. Accessed in 3 Dec 2018.
  29. 29.
    Sung KC, Ryu S, Cheong ES, et al. All-cause and cardiovascular mortality among Koreans: effects of obesity and metabolic health. Am J Prev Med. 2015;49(1):62–71.CrossRefPubMedGoogle Scholar
  30. 30.
    Health Insurance Review and Assessment Service. Available from: http://www.hira.or.kr/main.do. Accessed in 3 Dec 2018.
  31. 31.
    Healthcare Bigdata Hub. Available from: https://opendata.hira.or.kr.
  32. 32.
    Song HJ, Lee EK. Evaluation of willingness to pay per quality-adjusted life year for a cure: a contingent valuation method using a scenario-based survey. Medicine (Baltimore). 2018;97(38):e12453.CrossRefGoogle Scholar
  33. 33.
    Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.CrossRefPubMedGoogle Scholar
  34. 34.
    Sierzantowicz R, Lewko J, Hady HR, et al. Effect of BMI on quality of life and depression levels after bariatric surgery. Adv Clin Exp Med. 2017;26(3):491–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Zachariah SK, Chang PC, Ooi AS, et al. Laparoscopic sleeve gastrectomy for morbid obesity: 5 years experience from an Asian center of excellence. Obes Surg. 2013;23(7):939–46.CrossRefPubMedGoogle Scholar
  36. 36.
    Zhang Y, Zhao H, Cao Z, et al. A randomized clinical trial of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for the treatment of morbid obesity in China: a 5-year outcome. Obes Surg. 2014;24(10):1617–24.CrossRefPubMedGoogle Scholar
  37. 37.
    Hatoum IJ, Blackstone R, Hunter TD, et al. Clinical factors associated with remission of obesity-related comorbidities after bariatric surgery. JAMA Surg. 2016;151(2):130–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Puzziferri N, Roshek 3rd TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA. 2014;312(9):934–42.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Sach TH, Barton GR, Doherty M, et al. The relationship between body mass index and health-related quality of life: comparing the EQ-5D, EuroQol VAS and SF-6D. Int J Obes. 2007;31(1):189–96.CrossRefGoogle Scholar
  40. 40.
    Doring N, de Munter J, Rasmussen F. The associations between overweight, weight change and health related quality of life: longitudinal data from the Stockholm Public Health Cohort 2002-2010. Prev Med. 2015;75:12–7.CrossRefPubMedGoogle Scholar
  41. 41.
    Song HJ, Lee EK, Kwon JW. Gender differences in the impact of obesity on health-related quality of life. Asia Pac J Public Health. 2016;28(2):146–56.CrossRefPubMedGoogle Scholar
  42. 42.
    Tang Q, Sun Z, Zhang N, et al. Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus: a randomized controlled trial in China. Medicine (Baltimore). 2016;95(20):e3522.CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.College of Pharmacy and Research Institute of Pharmaceutical SciencesKyungpook National UniversityDaeguSouth Korea
  2. 2.Collega of Pharmacy, Yonsei Institute of Pharmaceutical SciencesYonsei UniversityIncheonSouth Korea
  3. 3.Department of SurgeryInha University School of MedicineIncheonSouth Korea

Personalised recommendations