Cost-Effectiveness of Pre-Pregnancy Bariatric Surgery [9C

Abstract

INTRODUCTION: We sought to determine if bariatric surgery is a cost-effective pre-pregnancy approach to reduce pregnancy complications in obese women. METHODS: We assessed the cost-effectiveness of bariatric surgery prior to becoming pregnant in a theoretical cohort of obese women age 20–39 in the United States. Outcomes included gestational diabetes (GDM), preeclampsia, preterm delivery, cesarean delivery, maternal mortality, and neurodevelopmental disability. All model inputs were derived from the literature. We calculated quality-adjusted life years (QALYs) to compare strategies, accounting for maternal and neonatal utilities. We ran our models with and without consideration of anovulation rates given its substantial impact on QALYs. RESULTS: Pre-pregnancy bariatric surgery led to lower rates of GDM, preeclampsia, and large-for-gestational-age infants, but more small-for-gestational-age (SGA) infants. Overall, no bariatric surgery was the preferred strategy with lower costs and better outcomes. However, when considering the impact on fecundity from improved ovulation rates after bariatric surgery, it would then become cost effective at $2,528 per QALY. Women who underwent pre-pregnancy bariatric surgery had higher rates of preterm delivery, SGA infants, cesarean delivery, maternal death and neonates with neurodevelopmental disabilities. Univariate sensitivity analyses showed that pre-pregnancy bariatric surgery became the preferred strategy when the probability of having an SGA baby became less than 0.121 from a baseline probability of 0.156. CONCLUSION: Bariatric surgery reduces the risk of GDM, preeclampsia and LGA infants, but it is not a cost-effective intervention in obese women of reproductive age. However, in women who are anovulatory, it may be a reasonable approach to improve overall pregnancy outcomes.