Abstract
BackgroundThe objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective.MethodsA decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources.ResultsBariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of €8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of €66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m2. Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime.ConclusionBariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.Electronic supplementary materialThe online version of this article (doi:10.1007/s11695-014-1567-5) contains supplementary material, which is available to authorized users.
Highlights
The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective
Surgery led to savings of €8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of €66 million for the cohort, operated in 2012
Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m2
Summary
The external validation showed that the model predicts the majority of clinical events GB gastric banding, GBP gastric bypass, MI myocardial infarction, OMM optimal medical management, SG sleeve gastrectomy health failure, angina, peripheral arterial disease, incidence and remission of diabetes) with a high degree of precision, there was a tendency to overestimate all-cause mortality and combined (fatal and non-fatal) myocardial infarction. In the base-case analysis, bariatric surgery was cost saving in comparison with conservative management. HF heart failure, MI myocardial infarction, OMM optimal medical management, PAD peripheral artery disease, TIA transient ischemic attack negative events (Table 2), from a 16 % reduction in the risk of transient ischaemic attack to a 62 % reduction in the incidence of type 2 diabetes. Over the lifetime of the cohort, surgery led to savings of €8408 and generated an additional 0.8 years of life or 4.1 QALYs per patient (Table 3). In Swedish settings, bariatric surgery becomes cost-effective (i.e., even though surgery may have higher cost, it leads to more benefits, and cost/ effect ratio is below accepted willingness-to-pay threshold in Sweden) after 2 years (ICER €26,985/QALY) and cost saving (i.e., surgery leads to more benefits at lower cost) after 17 years (Figure S5)
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