Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling

Abstract

BackgroundThe objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective.MethodsState-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€).ResultsOver 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs.ConclusionsBariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.

Bariatric surgery is a cost‐saving treatment for obesity—A comprehensive meta‐analysis and updated systematic review of health economic evaluations of bariatric surgery

“…Since September 2015, n = 24 health economic evaluations regarding bariatric surgery (with comparison to conventional treatment/no surgery or “before” versus “after” comparison) have been published. The distribution of economic reporting was similar to our previous narrative review, with 10 (42%) from European countries (UK 4, Denmark 2, Belgium 1, Italy 1, Germany 1, and Spain 1), six (25%) from the USA, three (13%) from Brazil, two (8%) from Australia and New Zealand, one (4%) each from Canada, Turkey, and China . Of special note was that 21% of studies (five out of n = 24) derived from developing countries, with two of these studies informed by Asian cohorts …”

“…After removing duplicate papers 1096 studies remained for title and abstract screening, with 63 studies included for full‐text review. Of these, 24 partial and full health economic evaluation studies were included in the updated systematic review . These studies were also assessed against the eligibility criteria for quantitative meta‐analyses together with the n = 77 eligible health economic evaluations from our previous systematic review (low part of Figure ).…”

“…Therefore, of the remaining 61 studies included in our meta‐analyses, 34 (56%) and 27 (44%) were based on partial and full health economic evaluations, respectively.…”

Is there improvement in renal function in patients undergoing bariatric surgery?

“…According to the literature, bariatric surgery is the best strategy for obesity with regard to effective and sustained weight loss. One can observe in this study, through the analysis of homogeneous samples for age and sex, a mass index signi icantly lower in the postoperative group [12,13,35,36].…”

“…In an attempt to reduce and slow down the onset and development of obesity and its manifestations, as well as improve quality of life of these individuals, treatment strategies have been used since lifestyle modi ications, medications as well as surgical interventions. In this context, bariatric surgery is proposed as one of the treatments for obese patients, with evidence of control of associated comorbidities [10][11][12][13][14]. cystatin-creatinine.…”