Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review

Abstract

There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.

A qualitative investigation of the health economic impacts of bariatric surgery for obesity and implications for improved practice in health economics

“…Demand for bariatric surgery far outstrips supply, particularly in public health care systems (Campbell, Hensher, Neil, Venn, Wilkinson, et al, ; Campbell, Venn, et al, ; Gregory, Temple Newhook, & Twells, ; Padwal et al, ; Sharman et al, ). Based on eligibility criteria, a recent Australian study determined that the potential demand for publicly and privately funded bariatric surgery in Australia was 882,441 adults aged between 18 and 65 years (Sharman et al, ), with 45.8% of these potential bariatric surgery candidates having no private health insurance (Sharman et al, ).…”

“…Constrained public sector budgets contribute to the incapacity of the Australian public health system to address the problems of severe obesity increasing more rapidly than obesity (Campbell, Venn, et al, ; Willis, Reynolds, & Keleher, ). The problem of demand for bariatric surgery far outstripping supply and constrained public sector budgets is reflected internationally (Campbell, Hensher, Neil, Venn, Wilkinson, et al, ; Gagner, ; Gill et al, ; Hall, ; Owen‐Smith et al, ).…”

“…Economic evaluation of bariatric surgery generally finds the intervention to be cost‐effective compared to nonsurgical interventions and possibly cost‐saving as an intervention for severely obese people with Type 2 diabetes (Borisenko et al, , Campbell, Venn, et al, ). Nevertheless, our recent comprehensive systematic review of the health economic reporting of bariatric surgery that included 77 heterogeneous partial and full health economic evaluations found that most of the included studies were informed by administrative quantitative data and analyses, a narrow payer perspective rather than a broader societal perspective, and out‐of‐pocket costs and productivity gains or losses were largely ignored (Campbell, Venn, et al, ). In turn, our review called for a more comprehensive investigation and reporting of the health economic outcomes of bariatric surgery to identify aspects of the bariatric surgery patient's journey that reached well beyond the primary surgery's direct medical costs (Campbell, Venn, et al, ).…”

“…Very few economic evaluations of bariatric surgery employ a broader societal perspective, and out‐of‐pocket costs and productivity losses are largely ignored. (Campbell, Venn, et al, ).…”

“…Within resource‐constrained health care budgets, demand far outstrips supply for bariatric surgery. Additionally, most economic evaluations of bariatric surgery adopt a narrow perspective and use administrative quantitative data to inform their quantitative analyses (Campbell, Venn, et al, ; Sharman et al, ).…”