Cost Effectiveness of Bariatric Surgery In Turkey: From A Long-Term Perspective

Abstract

According to the most recent data, obesity rate has increased to 19,9% in 2014 from 15,2% in 2008 in Turkey. Bariatric surgery is among the most recent treatment alternatives increasingly used for morbid obese patients. Reimbursement agencies face the challenge to fight with the cost of obesity and its co-morbidities and also with the cost of bariatric surgery. The main objective of this study is to assess the cost effectiveness of bariatric surgery from a 20 years perspective in Turkey. A Markov model was developed to show the long-term clinical and economic benefits of bariatric surgery. Cost effectiveness of gastric bypass (GBP) and sleeve gastrectomy (SG) were compared with standard of care (SoC) (diet exercise etc) for BMI≥40 patients. The model not only covers the impact of surgery on BMI but also on Type 2 diabetes, cardiovascular diseases, cancer (only in women) sleep apnea and knee pain and complications due to surgery. Analyses were made from the Turkish Social Security Institution’s (SSI) perspective and for both package and fee for service prices. Markov transition probabilities were obtained from published research, Turkish cost data were obtained from literature and expert views. Incremental QALYs were 2,59 and 2,63 for GBP and SG respectively. Both modes of bariatric surgery dominated SoC under fee for service payment. With package prices, incremental costs per patient were 4,287 TRY for GBP vs SoC and 3,573 TRY for SG vs SoC. Incremental cost per patients with T2DM was 3,770TRY for GBP vs SoC. The ICERs were 1,655 TRY and 1,357 TRY for GBP and SG respectively. For patients with T2DM the ICER was 3,370 TRY. The results showed that bariatric surgery is a cost effective option for the Turkish health care system both under package and fee for service prices.