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

Abstract

Objective: To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. Methods: A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. Results: In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. Conclusion: In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis.

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 …”

“…However, the results of the full health economic evaluations were generally consistent in their findings that bariatric surgery was cost‐effective compared with the reported jurisdiction's willingness to pay threshold, and in some studies cost saving amongst subgroups such as people with T2DM or a higher baseline BMI . Over a longer time horizon (≥ 10 years), bariatric surgery was a cost‐saving alternative to usual care for people with obesity and T2DM and still cost‐effective in patients without T2DM . Subgroup analyses also showed that bariatric surgery was consistently more cost‐effective as a person with obesity's initial BMI increased .…”

“…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.…”

“…Additionally, when costs were qualitatively synthesised, the review found heterogeneous results. For instance, across the depth and breadth of the comprehensive review's 77 included studies, some of the studies showed that the average total costs were higher in the bariatric group, whilst others revealed that the control group had higher costs . A narrative synthesis of the before and after bariatric surgery studies showed that total costs were higher after surgery in the shorter term …”