Costs Of Bariatric Surgery Research Articles

Your Weight and Your Wallet: Comparing Out-of-Pocket Costs of Bariatric Surgery and GLP1 Agonists.

Your Weight and Your Wallet: Comparing Out-of-Pocket Costs of Bariatric Surgery and GLP1 Agonists.

Economic evaluation of weight loss and transplantation strategies for kidney transplant candidates with obesity

Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness, risk profiles, and costs make strategy choices challenging. To aid decision-making, we used a Markov model to examine the cost-effectiveness of different WL strategies over a 10-year horizon. A target WL of 15% of total body weight was used for the base case scenario, and we compared these strategies to a “liberal” KT strategy of transplanting candidates with obesity. Outcomes included costs (2023 US dollars), quality-adjusted life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies, bariatric surgery was the most effective and cost the least, whereas lifestyle modification had the highest cumulative costs and was the least effective. Compared to liberal KT, bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes and cost-effectiveness.

Factors influencing the bariatric surgery treatment of bariatric surgery candidates in underdeveloped areas of China

BackgroundFrom year to year, the proportion of people living with overweight and obesity in China rises, along with the prevalence of diseases linked to obesity. Although bariatric surgery is gaining popularity, there are still several issues with its promotion compared to Western nations. Since less developed places in China are more widespread due to disparities in the development of different regions, there has been little exploration of the factors that might be related to acceptance of bariatric surgery in these regions.MethodsPatients who visited the Department of Gastrointestinal Surgery at the North Sichuan Medical College Affiliated Hospital from 2018 to 2022 and had obesity or other relevant metabolic problems were surveyed using a questionnaire. The relationship between demographic factors, socioeconomic status, and acceptance of bariatric surgery was analyzed.ResultsOf 334 patients, 171 had bariatric surgery. BMI, education level, marriage history, medical insurance, family support, and a history of type 2 diabetes were all linked to having bariatric surgery, according to a univariate analysis. In a multivariate analysis, BMI (P = 0.02), education (P = 0.02), family support (P<0.001), medical insurance coverage (P<0.001), and history of type 2 diabetes (P = 0.004) were all positively associated with a willingness to have bariatric surgery. Among 163 non-bariatric patients with obesity, 15.3% were not opposed to surgery but preferred trying medication first, 54.6% leaned towards medical therapy, and 30% were hesitant. Additionally, a majority of patients (48.55%) often lacked adequate knowledge about weight reduction therapy. Age, height, gender, smoking, drinking, family history of type 2 diabetes, education, and marital status did not significantly differ (P > 0.05).ConclusionsMany patients are concerned about the safety of surgical treatment and the possibility of regaining weight. Due to the relatively high cost of bariatric surgery, they tend to choose medical treatment. To enhance the acceptance of bariatric surgery in underdeveloped regions of China, it is crucial to focus on disseminating knowledge about bariatric surgery, offer pertinent health education to the community, and foster support from patients’ families. The government should pay more attention to obesity and provide support in the form of medical insurance.

Development and validation of a predictive model of the hospital cost associated with bariatric surgery

Hospitals are facing difficulties in predicting, evaluating, and managing cost-affecting parameters in patient treatments. Inaccurate cost prediction leads to a deficit in operational revenue. This study aims to determine the ability of Machine Learning (ML) algorithms to predict the cost of care in bariatric and metabolic surgery and develop a predictive tool for improved cost analysis. 602 patients who underwent bariatric and metabolic surgery at Wetzikon hospital from 2013 to 2019 were included in the study. Multiple variables including patient factors, surgical factors, and post-operative complications were tested using a number of predictive modeling strategies. The study was registered under Req 2022–00659 and approved by an institutional review board. The cost was defined as the sum of all costs incurred during the hospital stay, expressed in CHF (Swiss Francs). The data was preprocessed and split into a training set (80%) and a test set (20%) to build and validate models. The final model was selected based on the mean absolute percentage error (MAPE). The Random Forest model was found to be the most accurate in predicting the overall cost of bariatric surgery with a mean absolute percentage error of 12.7. The study provides evidence that the Random Forest model could be used by hospitals to help with financial calculations and cost-efficient operation. However, further research is needed to improve its accuracy. This study serves as a proof of principle for an efficient ML-based prediction tool to be tested on multi-center data in future phases of the study.

EE522 Budget Impact Model of Anti-Obesity Drugs and Bariatric Surgery in People With Obesity in South Korea

Despite an increase in countries reimbursing anti-obesity medications (AOMs) for selected populations, no AOMs are currently reimbursed in South Korea. We aimed to determine the budget impact of reimbursing AOMs compared with the annual cost of bariatric surgery in people with obesity in South Korea.

Long-term Impact of Laparoscopic Sleeve Gastrectomy on Drug Costs of Japanese Patients with Obesity and Type 2 Diabetes Mellitus.

Laparoscopic sleeve gastrectomy (LSG) is the most common type of bariatric surgery in Japan, and it is the only such procedure covered by national health insurance. The long-term cost of bariatric surgery in Japan has not yet been analyzed. We aimed to evaluate the long-term impact of LSG on the drug treatment costs of patients with type 2 diabetes mellitus (T2DM). We retrospectively analyzed data from 230 patients who had undergone LSG at our institution for their obesity and T2DM between 2007 and 2018. The clinicopathological data included age, sex, body mass index (BMI), as well as preoperative and postoperative medications for T2DM, hypertension, and dyslipidemia. We then calculated the drug treatment costs for T2DM, hypertension, and dyslipidemia before and after LSG; and we evaluated the remission rates of these obesity-related diseases. The median preoperative body weight and BMI of the 230 patients who underwent LSG were 115kg and 40.6kg/m2, respectively. Preoperative drug treatment costs per month per patient for T2DM, hypertension, and dyslipidemia were ¥3795 (¥0-40285), ¥3269 (¥0-14577), and ¥1428 (¥0-19464). Post-operation, the median drug treatment costs for all these diseases became nil. The remission rates of T2DM, hypertension, and dyslipidemia 5years after LSG were 82.8%, 50%, and 43.8%, respectively. In Japan, the cost of an LSG operation corresponds to 4.75years of median drug costs to treat T2DM and hypertension. In the long term, LSG in Japan is effective both physically and cost-wise for patients with obesity and T2DM.

The Effect of Bariatric Surgery on Healthcare Costs and Labor Market Attachment

PurposeWe aimed to estimate the total cost of bariatric surgery in Denmark.Materials and MethodsThe study population included all Danish citizens ≥ 18 years who had received bariatric surgery, identified in the Danish National Patient Register in the period from 2002 to 2018. Patients who had received bariatric surgery were matched with three controls on gender, year of birth, and region of residence. A difference-in-difference approach was used to estimate the healthcare costs attributable to bariatric surgery from 3 years before to 5 years after surgery.ResultsTotal healthcare costs for cases receiving bariatric surgery during the first 5 years following surgery amounted to EUR 32,899, and EUR 16,651 for their matched controls. Thereby, the difference in total healthcare costs (EUR 16,248) between persons receiving bariatric surgery and their matched controls was 2.2 times the DRG rate for the surgery itself (EUR 7387).Moreover, the results suggest that receiving bariatric surgery led to a total increase in gross earnings of EUR 5970 (5%) and a total reduction in receipt of transfer payments of EUR 4488 (12%) in the period up until 5 years after surgery.ConclusionThe results showed a significant and persistent increase in healthcare costs for people with obesity receiving bariatric surgery during the first 5 years after surgery. We also found that bariatric surgery was associated with increased attachment to the labor market.Graphical abstract

Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data

BackgroundThe increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities.MethodsThe study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery.ResultsThe preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention.ConclusionsTrends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.

PSU11 Resource Utilization and Disaggregated Cost Analysis of Bariatric Surgery in the Australian Public Healthcare System

To present a real-world micro-costing analysis of bariatric surgery in the Australian public healthcare system. In this retrospective cohort study, patients undergoing primary bariatric surgery (gastric banding [GB], gastric bypass [GBP] and sleeve gastrectomy [SG]) for the fiscal years 1st-July-2013 to 30th-June-19 were identified through the Tasmanian Department of Health’s administrative databases. Disaggregated, average-per-patient, and overall costs (2019 AU$) were presented. Subgroup analyses by surgical type were conducted. Annual population-based costs were calculated to capture longitudinal trends. A generalized linear model (GLM) was performed to predict the total costs for a base case scenario. 240 patients were included. Mean direct costs were $11,269 (US$7,799). The operating theatre cost bucket constituted the largest component of bariatric surgery-related costs, followed by costs for medical supplies, salaries, CCU use, and labour on-costs. Average costs for SG ($12,632) and GBP ($15,041) were higher than those for GB ($10,049). Operating theatre-related costs accounted for the largest component for SG and GBP, whilst medical supplies were the largest for GB. We observed an increase in SG/GBP and a decrease in GB procedures over time. Correspondingly, the main cost driver changed from medical supplies in 2014-2015 for GB procedures to operating theatre after 2014-2015 for SG/GBP procedures. In addition to surgery type, CCU use, number of comorbidities and the presence of complications were also associated with bariatric expenditures. GLM modelling of these parameters showed that the average cost for a representative cohort ranged from $7,580 to $36,633. This analysis presented the first detailed characterisation of the scale, disaggregated profile and determinants of costs of bariatric surgery and examined the evolution of resource utilization patterns and costs, reflecting the shift in Australian bariatric surgery landscape overtime. Understanding these patterns and forecasting of future changes are critical for healthcare resource allocation and sustainable budgetary planning.

Bariatric surgery is expensive but improves co-morbidity: 5-year assessment of patients with obesity and type 2 diabetes.

Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here. Population-based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006-2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co-morbidity Index (CCI) scores and co-morbidity rates were measured to compare changes in co-morbidities between surgically treated and control groups over 5 years. One-to-five propensity score matching was applied. Overall, 401 eligible surgical patients were matched with 1894 non-surgical patients. Direct medical costs were much higher for surgical than non-surgical patients in the index year (€36 752 and €5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5-year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5-year period, surgical patients had shorter length of stay in hospitals than non-surgical patients in year 2-5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P=0·016). Costs of glucose-lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose-lowering medications in year 2 (€973 versus €1395; P = 0.012). Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co-morbidity profile, and reduced length of hospitalization.

Cost-Effectiveness of Bariatric Surgery Prior to Posterior Lumbar Decompression and Fusion in an Obese Population with Degenerative Spondylolisthesis.

Cost-effectiveness analysis. To determine if bariatric surgery prior to posterior lumbar decompression and fusion (PLDF) for degenerative spondylolisthesis (DS) is a cost-effective strategy. Obesity poses significant perioperative challenges for DS. Treated operatively, obese patients achieve worse outcomes relative to non-obese peers. Concomitantly, they fare better with surgery than with nonoperative measures. These competing facts create uncertainty in determining optimal treatment algorithms for obese patients with DS. The role of bariatric surgery merits investigation as a potentially cost-effective optimization strategy prior to PLDF. We simulated a Markov model with two cohorts of obese individuals with DS. 10,000 patients with body mass index (BMI) more than or equal to 30 in both arms were candidates for both bariatric surgery and PLDF. Subjects were assigned either to (1) no weight loss intervention with immediate operative or nonoperative management ("traditional arm") or (2) bariatric surgery 2 years prior to entering the same management options ("combined protocol").Published costs, utilities, and transition probabilities from the literature were applied. A willingness to pay threshold of $100,000/QALY was used. Sensitivity analyses were run for all variables to assess the robustness of the model. Over a 10-year horizon, the combined protocol was dominant ($13,500 cheaper, 1.15 QALY more effective). Changes in utilities of operative and nonoperative treatments in non-obese patients, the obesity cost-multiplier, cost of bariatric surgery, and the probability of success of nonoperative treatment in obese patients led to decision changes. However, all thresholds occurred outside published bounds for these variables. The combined protocol was less costly and more effective than the traditional protocol. Results were robust with thresholds occurring outside published ranges. Bariatric surgery is a viable, cost-effective preoperative strategy in obese patients considering elective PLDF for DS.Level of Evidence: 3.

Bariatric surgery outcomes in Medicare beneficiaries.

BackgroundThe Medicare population is increasing while the prevalence of obesity remains high. Bariatric surgery is the most efficacious treatment of obesity and its comorbidities. The objective of this investigation was to assess trends in utilization, readmission, mortality, and cost of bariatric surgery in the Medicare population.MethodsUtilizing the Medicare Provider Analysis and Review database, patients with clinically severe obesity undergoing laparoscopic Roux‐en‐Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) from 2011–2015 were identified. Trends in procedure selection, readmissions, mortality, and cost were examined. A multivariable logistic regression analysis to evaluate factors associated with readmission and mortality was performed.ResultsOf the 73,718 patients identified, 53,949 (73%) of patients were enrolled in Medicare due to disability, 19,191 (26%) due to age, and 578 (<1%) due to end stage renal disease (ESRD). Utilization of SG increased (1% in 2011 to 61% in 2015), while utilization of RYGB (68% to 32%) and LAGB (31% to 1%) decreased. Length of stay (LOS) was highest after RYGB (2.54 days), and lowest after LAGB (1.32 days). LOS decreased from 2.23 days in 2011 to 2.12 days in 2015. Thirty‐day readmissions were 8.24% for the disabled, 5.5% for the elderly, 12.8% with ESRD. Odds of readmission increased with black race, higher body mass index (BMI), and RYGB. Readmission decreased from 8% in 2011 to 7% in 2015. Thirty‐day mortality was 0.22% in the disabled, and 0.28% in the elderly. Odds of 30‐day mortality increased among men, those with higher BMI, some comorbidities, and those who underwent RYGB. Cost of SG decreased while cost of RYGB increased.ConclusionsAmong the Medicare population, an increase in SG while a decrease in RYGB and LAGB utilization was noted from 2011–2015. Readmissions and cost have decreased, while mortality has remained low.

Gastric bypass in modern bariatric surgery

The Roux-en-Y Gastric bypass surgery has long been considered as the gold standard method for the surgical treatment of obesity and its complications. But at present, this position is disputed by supporters of one-anastomotic gastric bypass and sleeve gastrectomy. The decrease in the share of gastric bypass in the structure of bariatric operations is explained by technical complexity, surgical and malabsorption complications. This review reflects the main role of gastric bypass as a bariatric surgery in the treatment of obesity and metabolic syndrome, and discloses various options for the technical implementation of gastric bypass surgery according to Roux-en-Y and alternative one-anastomotic gastric bypass surgery. The advantages and disadvantages of the stapler-use and stapleless method for performing bariatric operations are shown. In our opinion, one of the promising alternative concepts for the surgical treatment of obesity is stapleless one-anastomotic direction in gastric bypass surgery, but the known stapleless methods are imperfect and unsafe. Thus, based on the presented literature review, we can conclude that the imperfection of not only the stapler gastric bypass methods, but also the stapleless method. Therefore, a further research is needed for alternative surgical methods that would reduce the likelihood of surgical complications, reduce the cost of bariatric surgery and increase the accessibility of surgical treatment of obesity for the population.

A Market Research Of Obesity And Bariatric Surgery In Turkey And Tunisia

This article aims to discuss four topics according to the recent scientific data a) to overview the frequency of obese and overweight individuals among Tunisia and Turkey populations; b) to examine health technology assessment of bariatric surgery (BS) report (HTA) in Tunisia and Turkey; c) to evaluate the cost and cost reimbursements by social health systems for bariatric surgery in Turkey and Tunisia; d) to examine the total number of bariatric surgical procedures and their costs in state and private health organizations in Tunisia and Turkey. The OECD (2011-2017) Turkey report was included for the data for the frequency of obese and over-weighted people among the general population Turkey, while the WHO report of «Diabetes Prevalence and Diabetes Risk Factors» of 2016 was included for Tunisia. Also supporting data on the overweight and obese population in Tunisia was provided from the news site named Middle East Monitor and the «Tunisian Health Examination Survey» conducted in 2016. Surgery cost and reimbursement of cost, analyses of bariatric surgery in Turkey published in 2014 was included as well. The data about the patient profile to whom bariatric surgery can be applied, the indications for bariatric surgery, and centers where it can be applied in Turkey are obtained from the Cost-Effectiveness of Obesity Surgery in Turkey and Economic Value Study (CEVOS-T) and Turkey Bariatric Surgery HTA Report. The Turkey Health Management Center website has been used for the total bariatric surgery performed. The authors analyzed the general status of bariatric operations in Turkey and Tunisia. The overweighted and obese individuals constitute 64.4% of Turkey’s population while this frequency is obtained as 62.8% of the Tunisian population. The rate of increase in obesity was obtained by 10.8% between 2014 to 2017 in Turkey. According to the results of CEVOS-T study the total economic burden attributable to an obesity rate of 1.16% of GDP in 2004, the proportion of the GDP in 2012 was seen as 1.73%. A total of 15,800 bariatric surgical procedures were performed in Turkey in 2018. The operational cost of a tube stomach surgery in the health unit of the Turkish Union of Public Hospitals (TKHK) was found to be 8930 TL. The cost of bariatric surgery in Tunisia including hospitalization is £ 3950. As the majority of the population is overweighted and obese in both Turkey and Tunisia, it can be interpreted as the occurrence of obesity-related health problems that can be increased. When the complications and advantages of bariatric surgery were examined it was decided that these two countries should give importance to bariatric surgery. Turkey’s interest in this subject is revealed with HTA and CEVOS-T report. Health economics analyses such as bariatric surgery HTA reports, number of bariatric surgery operations, the cost-effectiveness of BS in Tunisia could not be reached due to lack of statistics and resources. Turkey and Tunisia made with these investigations demonstrated a general situation in bariatric surgery. Keywords: bariatric surgery, health technology, market of bariatric surgery, obesity, overweight population.

Variation in Bariatric Surgery Costs and Complication Rates in the Military Health System.

Within the Military Health System (MHS), facilities have struggled to meet minimum recommended volume thresholds for certain procedures. Understanding variations in complication rates and cost can help policymakers tailor policy to target improvement. Our objective was to quantify the variation in bariatric surgery complication rates and costs across a sample of military hospitals. We study a retrospective cohort of 38 military surgeons practicing in 21 military treatment facilities from 2007 to 2014 who performed 1,277 bariatric surgeries. Data from the Centralized Credentials and Quality Assurance System, which provides education and training characteristics of physicians, were linked to patient encounter data from the MHS Data Repository. Physicians were included if they performed at least five bariatric surgeries over the study period. Patients were included if they had a diagnosis of obesity (body mass index > 30) and underwent a bariatric weight loss surgery. We calculated and summarized inpatient costs and complication rates across both surgeons and facilities using multivariable mixed-effects linear or logistic models. We used these models to calculate adjusted complication rates and average costs across both providers and hospitals to characterize variation in bariatric outcomes within the MHS. This study was considered exempt by the Uniformed Services University Institutional Review Board. We find evidence of large variations in both complication rates and costs per admission. Overall, we found a 15.5% complication rate across the sample. When comparing averages across facilities, we find large variation in complications (49.4% coefficient of variation [CV]) and procedure costs (25.9% CV). Controlling for patient comorbidities, BMI, and year attenuates much of the variation (12.6% CV complications, 4.4% CV cost), but cannot completely explain differences across facilities. Our model suggests that complications cost 32% more than complication-free surgeries on average suggesting that quality improvement efforts could potentially yield large savings. We find large variations in complication rates even after controlling for patient health. Furthermore, surgical complications are a significant determinant of cost. Policymakers should target efforts to improve surgical quality across facilities and physicians. Surgical quality improvement initiatives could produce savings to the MHS through reduced complications and improved surgical readiness.

Costs of bariatric surgery in an Australian public hospital setting

Costs of bariatric surgery in an Australian public hospital setting

Can we cure type 2 diabetes?

Can we cure type 2 diabetes?

PMD22 COST-BENEFIT ANALYSIS OF BARIATRIC SURGERY FROM A PRIVATE AND PUBLIC THIRD-PARTY PAYER PERSPECTIVE IN CHILE

Obesity affects one third of the adult population in Chile. Bariatric Surgery (BS) has the potential of improving health status and saving future medical costs through reduced medical care for conditions associated with Obesity. We conducted a Cost-Benefit analysis of BS from the perspective of public (FONASA) and private (ISAPRES) health insurers in Chile. We compared the cost of Bariatric Surgery and Related Costs (BSRC) including surgical complications, reoperations and future abdominoplasties with expected cost savings on BS patients resulting from a reduction in the incidence and prevalence of Diabetes, Hypertension, Cardiovascular events, and female cancers calculated for a cohort of patients over a 10-year time horizon with characteristics similar to those in the Swedish Obese Subjects Study. Data on annual treatment costs of comorbidities where extracted from a national claims database for ISAPRES and from a national costing study for FONASA. Private insurers billing databases with a 5-year follow-up where used to estimate BS costs and incidence and costs of surgical complications, BS reoperations and abdominoplasties in that time frame, with the assumption of equivalent incidence in private and public insurers. 5.1% of cases had surgical complications requiring rehospitalization, 6.6% of patients had a new BS procedure and 5.5% had abdominoplasties. BSRC for ISAPRES and FONASA was US$ 6,218 and US$ 5,889 respectively. The present value of expected savings from improved future health status in patients undergoing BS was estimated to be US$ 1,360 for FONASA and US$ 1,883 for ISAPRES over 10 years. These estimates imply that the expected savings from avoiding obesity complications represent 23% of the cost of BSRC in FONASA and 30% in ISAPRES. Cost savings related to comorbidities in obese patients resulting from BS account for about one-fourth of the cost of BS in FONASA and about one-third in ISAPRES.

What is the Cost of Bariatric Surgery

What is the Cost of Bariatric Surgery

Cost-Effectiveness Analysis of Bariatric Surgery for Morbid Obesity.

In the USA, three types of bariatric surgeries are widely performed, including laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic adjustable gastric banding (LAGB). However, few economic evaluations of bariatric surgery are published. There is also scarcity of studies focusing on the LSG alone. Therefore, this study is evaluating the cost-effectiveness of bariatric surgery using LRYGB, LAGB, and LSG as treatment for morbid obesity. A microsimulation model was developed over a lifetime horizon to simulate weight change, health consequences, and costs of bariatric surgery for morbid obesity. US health care prospective was used. A model was propagated based on a report from the first report of the American College of Surgeons. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained were used in the model. Model parameters were estimated from publicly available databases and published literature. LRYGB was cost-effective with higher QALYs (17.07) and cost ($138,632) than LSG (16.56QALYs; $138,925), LAGB (16.10QALYs; $135,923), and no surgery (15.17QALYs; $128,284). Sensitivity analysis showed initial cost of surgery and weight regain assumption were very sensitive to the variation in overall model parameters. Across patient groups, LRYGB remained the optimal bariatric technique, except that with morbid obesity 1 (BMI 35-39.9kg/m2) patients, LSG was the optimal choice. LRYGB is the optimal bariatric technique, being the most cost-effective compared to LSG, LAGB, and no surgery options for most subgroups. However, LSG was the most cost-effective choice when initial BMI ranged between 35 and 39.9kg/m2.