Systematic assessment of decision analytic models for the cost-effectiveness of bariatric surgery for morbid obesity

Alsumali, Adnan; Al-Hawag, Ali; Samnaliev, Mihail; Eguale, Tewodros

doi:10.1016/j.soard.2018.03.005

Cited by 19 publications

(26 citation statements)

References 41 publications

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“…The findings were informed by narrower selection criteria where n = 23 decision analytic models of bariatric surgery were qualitatively narrated . Additionally, five recently published European modelling studies not included in the aforementioned decision‐analytical modelling systematic review also demonstrated that bariatric surgery was cost effective over a 10‐year time horizon and cost saving for a lifetime horizon . Based on substantial high‐quality full economic evaluations, our cumulative cost meta‐analytical model further enhanced the evidence that bariatric surgery was a cost‐saving alternative to conventional management over the lifetime.…”

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

“…In 2018, a systematic review of decision‐analytical models found that bariatric surgery was cost effective when compared with conventional management, and cost savings were observed in the patients with T2DM, patients with higher initial BMI, and younger patients . The findings were informed by narrower selection criteria where n = 23 decision analytic models of bariatric surgery were qualitatively narrated . Additionally, five recently published European modelling studies not included in the aforementioned decision‐analytical modelling systematic review also demonstrated that bariatric surgery was cost effective over a 10‐year time horizon and cost saving for a lifetime horizon .…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, the previous review also investigated and synthesised the results for the past systematic reviews to identify knowledge gaps. For our current comprehensive review and quantitative meta‐analyses, we identified three further systematic reviews in the published literature from June 2015 . In summary, these studies adopted relatively narrow inclusion criteria (compared with our previous and current reviews) that translated to only a small number of studies being considered.…”

Section: Introductionmentioning

confidence: 99%

“…The first study investigated medication cost changes for before versus after surgery for only n = 9 studies . The second review investigated n = 13 partial economic evaluations in which the sources and methods of data collection were minimally reported, whilst the third review investigated the decision analytic models for the cost‐effectiveness of bariatric surgery for morbid obesity . Notably the third review did not investigate the aggregated cost data of these studies …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

et al. 2019

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Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

Kostic

Leifer

Gong

et al. 2022

Arthritis Care & Research

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Objective. Class III obesity (body mass index [BMI] ≥40 kg/m 2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m 2 , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m 2 .Methods. We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and costeffectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.Results. The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m 2 , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively.Conclusion. RYGB offers good value among knee OA patients with BMI ≥40 kg/m 2 , while LSG may provide good value among those with BMI between 35 and 41 kg/m 2 .

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Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System

et al. 2019

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Purpose Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system. Materials and Methods A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate. Results Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs. ConclusionThe study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.

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Systematic assessment of decision analytic models for the cost-effectiveness of bariatric surgery for morbid obesity

Cited by 19 publications

References 41 publications

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

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

Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System

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