Objective: One-third of Americans are obese and an increasing number opt for bariatric surgery. This study estimates the cost-effectiveness of common bariatric surgical procedures from a healthcare system perspective. Methods: We evaluated the three most common bariatric surgical procedures in the US: laparoscopic gastric bypass (LRYGB), conventional (open) Roux-en-Y gastric bypass (ORYGB), and laparoscopic adjustable gastric banding (LAGB) compared to no surgery. The reference case was defined as a 53-year old female with body mass index (BMI) of 44 kg/m2. We developed a two-part model using a deterministic approach for the first 5-year period post-surgery and separate empirical forecasts for the natural history of BMI, costs and outcomes in the remaining years. We used a combination of datasets including Medicare and MarketScan® together with estimates from the literature to populate the model. Results: Bariatric surgery produced additional life expectancy (80-81 years) compared to no surgery (78 years). The incremental cost-effectiveness ratios (ICERs) of the surgical procedures were US $6,600 per quality-adjusted life expectancy (QALY) gained for LRYGB, US $6,200 for LAGB, and US $17,300 for ORYGB (3 % discount rate for cost and QALYs). ICERs varied according to choice of BMI forecasting method and clinically plausible variation in parameter estimates. In most scenarios, the ICER did not exceed a threshold of US $50,000 per QALY gained. © 2013 Springer-Verlag Berlin Heidelberg.
CITATION STYLE
Wang, B. C. M., Wong, E. S., Alfonso-Cristancho, R., He, H., Flum, D. R., Arterburn, D. E., … Sullivan, S. D. (2014). Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity. European Journal of Health Economics, 15(3), 253–263. https://doi.org/10.1007/s10198-013-0472-5
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