Clinical Indications, Utilization, and Funding of Bariatric Surgery in Europe

Abstract

PurposeThe objective of this study was to evaluate the current utilization, the level of endorsement by professional societies, and health technology assessment bodies, as well as the reimbursement levels for bariatric surgery in European countries.Materials and MethodsWe performed an analysis of the indications for bariatric surgery based on national clinical and commissioning guidelines, current utilization of surgery, characteristics of patients who underwent surgery, and reimbursement tariffs in Belgium, Denmark, England, France, Germany, Italy, and Sweden. Data were obtained from national patient registries, administrative databases, and published literature for the year 2012.ResultsDespite clear consensus outlined in clinical guidelines, significant differences were found in the eligibility criteria for surgery. Patients with no significant comorbidities were deemed eligible if they had a body mass index (BMI) of 40 or 50 kg/m2 in Denmark. Irrespective of the country, patients with comorbidities were eligible if they had a BMI of 35 kg/m2. The highest utilization of bariatric surgery (number of surgeries per 1 M population) was observed in Belgium (928), Sweden (761), and France (571) while Italy (128), England (117), and Germany (72) had the lowest utilization. There was a strong negative correlation between utilization and average BMI level of the patient population (r = −.909, p = 0.005). The annual per capita spending on surgery differed significantly between countries, ranging from €0.54 in Germany to €4.33 in Belgium.ConclusionsThere are significant variations in the clinical indications, utilization, and funding of bariatric surgery in European countries.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-014-1537-y) contains supplementary material, which is available to authorized users.

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

“…A recent analysis of utilization of bariatric surgery in seven European countries showed that Italy has one of the lowest rates of bariatric surgery interventions (128 procedures per 1 million population), compared with Europe's average (401 procedures per 1 million population) [68]. However, the frequency of bariatric surgery interventions in England and Germany is even lower, with 117 and 72 procedures per 1 million population, respectively [67]. …”

Current challenges in providing bariatric surgery in France

“…[9] Data from Europe indicate that France is now the country with the highest bariatric surgery rate alongside with Belgium and Sweden. [3] This could be explained by a favorable policy context and unlimited access to bariatric surgery in France, despite the relatively modest prevalence rates of 3.1% and 1.2% for grade II and III obesity, respectively, compared to other European countries. A current specificity of France compared to other European countries is also the current and growing choice of LSG rather than other procedures.…”

“…And these determinants vary across the world and even within Europe. [3] The decision process is easier in type 2 diabetic patients [4] since several large randomized trials indicate some superiority for Roux-en-Y gastric bypass (RYGB) compared to longitudinal sleeve gastrectomy (LSG).…”

Abandono de la terapia nutricional y pérdida de peso en pacientes bariátricos: Cohorte retrospectiva en Lima, Perú

“…Sin embargo, el contenido de dicha guía no está disponible para el público. A pesar de un consenso claro en protocolos clínicos, en un estudio involucrando distintos países europeos 5 , los pacientes eran elegibles sin comorbilidades si su IMC se encontraba entre 40-50kg/m 2 en Dinamarca e Inglaterra, mientras que en el resto de países eran elegibles con comorbilidades y un IMC mayor a 35kg/m 2 . Además, aproximadamente el 5,4% de la población adulta podría ser elegible para cirugía bariátrica 9 (90) 20 (74,1) 16 (94,1) 9 (81,8) 4 (100) ,8) 7 (21,9) 1 (10) 7 (25,9) 1 (5,9) 2 (18,2) 0 (0) 1 ( .…”

“…En Estados Unidos y Europa se han establecido protocolos a nivel nacional para cirugía bariátrica, en los cuales se resaltan las indicaciones para elegir al candidato a ser sometido a cirugía bariátrica y se enfatiza el monitoreo del paciente por un equipo multidisciplinario (médico, psicólogo, nutricionista) antes y después de la cirugía [5][6][7] . Entre los países en el primer, tercer y sexto mes del tratamiento nutricional con la tasa de abandono del mismo; así como, determinar la proporción de pacientes que cumplen los criterios internacionales de gastrectomía en manga.…”