Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden

Abstract

Abstract:The rising trend in the prevalence of obesity has become a major public health concern in many countries during the past decades, partly because being obese is associated with comorbidities and death. The cost of treatment for obesity related diseases has become a heavy burden on the national health care budget in many countries. The treatment options for obesity are mainly weight management therapies in the form of diet and exercise, pharmacological therapy, and surgery. The incidence of bariatric surgery in Sweden has increased eight-fold in the last decade. Our objective was to assess the cost-effectiveness of gastric bypass surgical treatments for obesity in adult patients, in comparison with conventional treatment, in Sweden from a societal perspective. The conventional treatment alternative consisted of the prevalent mixture of non-surgical obesity treatments. A model of individual patients was used to simulate the outcomes of the patients in terms of treatment costs, indirect costs, life years, and quality adjusted life years (QALY) over a lifetime perspective. In patients with a Body Mass Index of 40-44 kg/m 2 , surgery was estimated to be cost-saving in men and judged cost-effective in women, with an incremental cost per QALY gained of SEK 26 thousand (EUR 3 thousand). The incremental cost associated with gastric bypass decreases with BMI, increases with the patient's age, and is higher in women than in men. Taking patient characteristics and uncertainty in input data and model design into account, the incremental cost is estimated to be at most SEK 160 thousand per QALY gained (about EUR 18 thousand per QALY). In conclusion, gastric bypass surgery appears to be a cost-effective intervention compared to conventional treatment in adult persons with obesity in Sweden.

Adaptation of cost-effectiveness analyses to a single country: the case of bariatric surgery for obesity and overweight

“…This alternative approach to calculating adapted costs and ICERs had no large effect. There were no substantial differences for the studies by Borg et al [27] and Castilla et al [29], which were quite recent (cost year 2012). The largest impact on ICERs was seen for the older studies by Clegg et al (2003) [10] (difference −31.70%) and Craig et al [22] (difference −28.07%) (appendix 13).…”

“…The adaptation of cost-effectiveness results may have allowed a comparison of results across studies, and an approximation of cost-effectiveness levels to be expected for Switzerland. The majority of studies were from a payer perspective [3,10,22,26,28,29,31,34,50] and two were from a societal perspective [27,33]. It should be noted that adapted ICERs from a payer perspective may reflect a Swiss statutory health insurance perspective (taking into account the direct medical costs of all healthcare services covered by the Swiss statutory health insurance, irrespec- In the case of studies providing results for different patient groups, results were selected for presentation based on the longest available time horizon (if there was more than one time horizon available), female gender (when available in the study) and BMI >35 kg/m 2 .…”

“…Ackroyd et al [26] described results based on three different countries, Campbell et al [28] for two estimates of treatment effects (by Angrisani [48] and O'Brien [49]), Hoerget et al [30] for two diabetes groups, Wang et al [36] for two types bypass surgeries and gastric banding, and Picot et al for two different banding techniques. From the Borg et al study [27], we selected the results for female patients aged 45-54 years, with BMI 40 kg/m 2 . tive of actual payer), rather than an immediate insurer perspective.…”

“…Only Michaud et al [33] reported total lifetime medical costs (disease-specific and disease-nonspecific costs). Only two studies included a societal perspective and reported indirect costs [27,33]. The accuracy in reporting types of costs and the sources of cost data used varied.…”

“…The remainder were from continental Europe. All studies were published between 2002 and 2014 and all but two (Craig et al,Borg et al) [22,27] reported funding sources. The perspectives of the studies were different.…”