Abstract
BackgroundThe objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective.MethodsState-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€).ResultsOver 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs.ConclusionsBariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
Highlights
The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective
Base-case results in multiple cohorts extrapolated from German quality Assurance in Bariatric Surgery Registry In the base-case analysis at 10 years, bariatric surgery was associated with higher costs of €2909, an additional
0.03 life years, and 1.2 quality-adjusted lifeyears (QALY), which resulted in an incremental cost-effectiveness ratio of €2457 when compared to conventional medical management
Summary
The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective. When conservative approaches to manage obesity fail, bariatric surgery represents the only effective method of weight reduction. The German society for general and visceral surgery (DGAV) guideline recommends bariatric surgery for patients with a body mass index (BMI) of >40 kg/m2 after failure of conservative management. In the presence of type 2 diabetes (T2D), the guideline recommends to lower the threshold to as low as BMI > 35 kg/m2 [11]. The utilization of surgery in Germany is still relatively low compared with other European countries, with
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