Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model

Abstract

BackgroundThe objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective.MethodsA decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources.ResultsBariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of €8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of €66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m2. Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime.ConclusionBariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-014-1567-5) contains supplementary material, which is available to authorized users.

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…The study found that bariatric surgery was a cost-effective intervention for morbid obesity, with ICERs ranging between £2000 and £4000 per QALY gained over a 20-year time horizon. 31 A more recent study suggested that bariatric surgery may be cost saving for health-care systems through reduced morbidity, 175 though this conclusion has been disputed. 178 Although bariatric surgery does not appear to generate cost savings, its use is associated with substantial health gains at costs that are well below accepted thresholds for cost-effectiveness.…”

Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling

“…This study has a number of limitations, as previously discussed [23]. In brief, the analysis did not include all potential obesity-related complications and potentially underestimated cost benefits of surgery.…”

“…Full details of the modeling approach, data inputs, and validation activities are reported elsewhere [23]. In brief, obese patients may undergo surgery or continue optimal medical management, experience post-surgery complications or have no complications, develop type 2 diabetes mellitus (T2DM) or cardiovascular diseases (angina, myocardial infarction, stroke, heart failure, and peripheral artery disease), recover from T2DM, or die (fig.…”

For a Step Change to Curb the Obesity Epidemic

“…Bariatric surgery has emerged as the first (and, so far, only) technology associated with significant success against severe obesity [29][30][31] and its associated comorbidities [32] for a large proportion of treated patients. The procedure has demonstrated significant cost savings and return on investment for patients with class 3 obesity (i.e., BMI C40.0 patients) [33][34][35][36][37][38][39][40][41] and may be of benefit for other categories of patients [19]. However, its use remains largely confined to the morbidly obese and limited by various obstacles [19,42]).…”