Abstract
BackgroundTo examine the cost-effectiveness of providing laparoscopic adjustable gastric banding (LAGB) surgery to all morbidly obese adults in the 2003 Australian population.Methods and FindingsAnalyzed costs and benefits associated with two intervention scenarios, one providing LAGB surgery to individuals with BMI >40 and another to individuals with BMI >35, with each compared relative to a ‘do nothing’ scenario. A multi-state, multiple cohort Markov model was used to determine the cost-effectiveness of LAGB surgery over the lifetime of each cohort. All costs and health outcomes were assessed from an Australian health sector perspective and were discounted using a 3% annual rate. Uncertainty and sensitivity analyzes were conducted to test the robustness of model outcomes. Incremental cost-effectiveness ratios (ICERs) were measured in 2003 Australian dollars per disability adjusted life year (DALY) averted.The ICER for the scenario providing LAGB surgery to all individuals with a BMI >40 was dominant [95% CI: dominant - $588] meaning that the intervention led to both improved health and cost savings. The ICER when providing surgery to those with a BMI >35 was $2 154/DALY averted [95% CI: dominant - $6 033]. Results were highly sensitive to changes in the likelihood of long-term complications.ConclusionLAGB surgery is highly cost-effective when compared to the $50 000/DALY threshold for cost-effectiveness used in Australia. LAGB surgery also ranks highly in terms of cost-effectiveness when compared to other population-level interventions for weight loss in Australia. The results of this study are in line with other economic evaluations on LAGB surgery. This study recommends that the Australian federal government provide a full subsidy for LAGB surgery to morbidly obese Australians with a BMI >40.
Highlights
Morbid obesity, defined as a body mass index (BMI) of 40 or more, is a serious condition that puts the patient at very high risk of diabetes, heart disease, and musculoskeletal disorders [1]
laparoscopic adjustable gastric banding (LAGB) surgery is highly cost-effective when compared to the $50 000/disability adjusted life year (DALY) threshold for cost-effectiveness used in Australia
LAGB surgery ranks highly in terms of cost-effectiveness when compared to other population-level interventions for weight loss in Australia
Summary
Morbid obesity, defined as a BMI of 40 or more, is a serious condition that puts the patient at very high risk of diabetes, heart disease, and musculoskeletal disorders [1]. Laparoscopic adjustable gastric banding (LAGB) presently accounts for 90% of all bariatric procedures conducted in Australia [6], and is commonly performed in Europe and South America [7,8]. Recent meta-analyses show that LAGB leads to a 45–50% excess weight loss (%EWL), which is the percentage weight loss after surgery relative to the difference between pre-operative weight and an ideal weight (e.g., weight at BMI 25 kg/m2) [9,10]. This corresponds with an average weight loss of 30 kg or 10 BMI units. To examine the cost-effectiveness of providing laparoscopic adjustable gastric banding (LAGB) surgery to all morbidly obese adults in the 2003 Australian population
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