Cost-Utility of Bariatric Surgery In France And Germany

Abstract

Objectives: To evaluate the cost-utility of bariatric surgery in Germany and France from a third-party payer perspective over a mid-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, data about effectiveness and safety of surgery, costs, and utilities were informed by the literature, patient registries and administrative databases. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was internally and externally validated, the deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. A base-case analysis was performed for the population of real surgical candidates in both countries. Cost data are presented in 2012 euros. Results: In Germany, in the base-case analysis over 10 years bariatric surgery led to incremental cost of € 2,909 and generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs) with incremental costeffectiveness ratio of € 2,457/QALY. Over lifetime, surgery led to savings of € 8,522, and generated additional 0.7 years of life, and 3.2 QALYs. In France, in the base-case analysis over 10 years bariatric surgery led to incremental cost of € 1,106 and generated additional 1.3 QALYs with incremental cost-effectiveness ratio of € 852/QALY. Over lifetime surgery lead to savings of € 8,359, additional 0.5 life years, and 3.4 QALYs. In both countries surgery was also associated with reduction of incidence of diabetes and cardiovascular disorders. One- to three-year delay in provision of surgery led to reduction of clinical effectiveness, but had diverse impact on total cost in different patient cohorts. Conclusions: 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 time horizon in Germany and France.