Cost-effectiveness Of Bariatric Surgery Research Articles

Cost-Effectiveness of Bariatric Surgery in Patients Living with Obesity and Type 2 Diabetes.

The favourable effects of bariatric surgeries on body weight reduction and glucose control have been demonstrated in several studies. Additionally, the cost-effectiveness of bariatric surgeries has been confirmed in several analyses. The aim of the current analysis was to demonstrate the cost-effectiveness of bariatric surgeries in obese patients with type 2 diabetes in Hungary compared to conventional diabetes treatments based on economic modelling of published clinical trial results. Patients entered the simulation model at the age of 45 with body mass index (BMI) ≥ 30 kg/m2 and type 2 diabetes. The model was performed from the public payer's perspective, comparing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) procedures to conventional care of diabetes. The results were provided separately for three BMI categories. The base-case analysis demonstrated that both surgery types were dominant; i.e., they saved 17 064 to 24 384 Euro public payer expenditures and resulted in improved health outcomes (1.36 to 1.50 quality-adjusted life years gain (QALY)) in the three BMI categories. Bariatric surgeries extended the life expectancy and the disease-free survival times of all the investigated diabetes complications. All the scenario analyses confirmed the robustness of the base-case analysis, such that bariatric surgeries remained dominant compared to conventional diabetes treatments. The results of this cost-effectiveness analysis highlight the importance of bariatric surgeries as alternatives to conventional diabetes treatments in the obese population. Therefore, it is strongly recommended that a wider population has access to these surgeries in Hungary.

Cost-Effectiveness of Bariatric Surgery in Tunisia.

Obesity is a growing global issue with evidence linking it to an increase in loss of disease-free years, reduced quality of life, increased mortality, and additional economic burden. This study sought to establish the cost-effectiveness of gastric bypass and sleeve gastrectomy, compared to conventional therapy in patients with obesity, from a Tunisian healthcare payor perspective. A Markov model compared lifetime costs and outcomes of bariatric surgery with conventional treatment among patients with body mass index (BMI) ≥ 40 kg/m2, BMI ≥ 35 kg/m2 with obesity-related co-morbidities (Group 1), or BMI ≥ 35 kg/m2 with type 2 diabetes mellitus (T2DM) (Group 2). Inputs were sourced from the Tunisian Health Examination Survey, local clinician data and literature sources. Health states were associated with different cost and utility decrements. Changes in body mass index, systolic blood pressure, lipid ratio and diabetes remission rates were modelled on a yearly basis. The incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs) and net monetary benefit (NMB) were key outcomes. Sensitivity and scenario analyses were performed to test the model's robustness. The model showed that the benefits of bariatric surgery were favorable compared to conventional treatment, with an ICER of 1844 TND/QALY in Group 1 patients and 2413 TND/QALY in Group 2 patients. Bariatric surgery resulted in a QALY gain of 3.26 per patient in Group 1 and a gain of 1.77 per patient in Group 2. At a willingness to pay threshold of 31,379 TND/QALY, the incremental NMB was 96,251 TND and 51,123 TND for Group 1 and Group 2, respectively. From the Tunisian healthcare payor perspective, bariatric surgery is cost-effective for patients with obesity and those with T2DM and obesity-related comorbidities. These findings may have impact on future decision-making on funding and reimbursement of bariatric surgery in Tunisia.

Back to Work After Bariatric Surgery? A Belgian Population Study.

Aside from an impact on health, obesity is also associated with higher social and economic costs such as impaired productivity, increased work absenteeism, and higher rates of unemployment. The aim of this study was to assess the effect of bariatric surgery on employment status in a large nationwide database, using data from all patients that underwent bariatric surgery in Belgium. This is a retrospective analysis of all Belgian patients that underwent bariatric surgery between 2014 and 2015. The work status of these patients was examined yearly: 4years before and 3years after surgery. Increased employment after surgery was defined (1) as a reduction in days of unemployment and incapacity and (2) as the resumption of work among the unemployed. In total, 16,276 patients were included. The number of working people rose from 49.7% before to 61.2% 3years after bariatric surgery, i.e., an increase of 11.5% between pre- and post-surgery. The largest improvement in reduction in unemployment was found in individuals who were absent from work for more than 9months, namely, a reduction from 13.4 to 7.2%. In the population of unemployed patients, 20.9% became employed after bariatric surgery. We found an increase in employment rate and a decrease in work incapacity and unemployment after bariatric surgery. Higher rates of employment after bariatric surgery may also contribute to an increased cost-effectiveness of bariatric surgery. It would be interesting to research possible targeting strategies to increase the employment rate even more after bariatric surgery.

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

ObjectivesTo determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.MethodsAn economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.ResultsRYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.ConclusionsRYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

The Health Economic Evaluation of Bariatric Surgery Versus a Community Weight Management Intervention Analysis from the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT).

Background: The Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) established the efficacy of bariatric surgery as compared to a community weight management intervention in reducing intracranial pressure in active IIH. The aim of this cost-effectiveness analysis was to evaluate the economic impact of these weight loss treatments for IIH. Methods: IIH:WT was a five-year randomised, controlled, parallel group, multicentre trial in the United Kingdom, where participants with active IIH and a body mass index ≥35 kg/m2 were randomly assigned (1:1) to receive access to bariatric surgery or a community weight management intervention. All clinical and quality of life data was recorded at baseline, 12 and 24 months. Economic evaluation was performed to assess health-care costs and cost-effectiveness. Evaluations were established on an intention to treat principle, followed by a sensitivity analysis using a per protocol analysis. Results: The mean total health care costs were GBP 1353 for the community weight management arm and GBP 5400 for the bariatric surgery arm over 24 months. The majority of costs for the bariatric surgery arm relate to the surgical procedure itself. The 85% who underwent bariatric surgery achieved a 12.5% reduction in intracranial pressure at 24 months as compared to 39% in the community weight management arm; a mean difference of 45% in favour of bariatric surgery. The cost effectiveness of bariatric surgery improved over time. Conclusions: The IIH:WT was the first to compare the efficacy and cost-effectiveness of bariatric surgery with community weight management interventions in the setting of a randomised control trial. The cost-effectiveness of bariatric surgery improved over time and therefore the incremental cost of surgery when offset against the incremental reduction of intracranial pressure improved after 24 months, as compared with 12 months follow up.

Cost effectiveness of bariatric surgery in patients with obesity related comorbidities: A retrospective study.

Background and Aim:Bariatric surgery has been reported to be an effective but expensive method for obesity management. This study aimed to determine the economic benefit for patients who underwent bariatric surgery.Methodology:We conducted a retrospective chart review of patients who underwent bariatric surgery and was on medications for obesity-related comorbidities at the Obesity Research Center in King Khalid University Hospital, Riyadh, Saudi Arabia. Data on the use and cost of medications before and after bariatric surgery were collected.Results:A total of 266 patients, 107 males (40.23%), and 159 Females (59.77%) with a mean age of 41.06 years were included in the study. There was a reduction in the mean number of medications used by patients before and 1-year post-op (before: 1.84, after: 0.52), with a significant reduction in the cost of medications (SAR5152.24 before, and SAR1695.36 after, 67% reduction, P < 0.001). Patients < 32 years old had the most reduction in medications cost (76.64% reduction). No significant difference in the cost reduction after surgery between genders (P = 0.971). There were significant reductions in numbers of out-patient clinic visits (2.26 ± 2.43 to 1.57 ± 1.42) and in-patient hospitalizations (0.31 ± 0.57 to 0.10 ± 0.36) after surgery (P < 0.001 and P < 0.001, respectively).Conclusion:Bariatric surgery can be considered as a cost-effective treatment for patients with obesity-related comorbidities. A significant reduction has been found in post-operative medications cost, out-patient clinic visits and in-patient hospitalizations after bariatric surgery.

Clinical evidence of the cost effectiveness of bariatric surgery in management of type 2 diabetes mellitus and obesity to prevent associated co-morbidity

Clinical evidence of the cost effectiveness of bariatric surgery in management of type 2 diabetes mellitus and obesity to prevent associated co-morbidity

The Clinical Effectiveness and Cost Effectiveness of Bariatric Metabolic Surgery for Obese with Poorly Controlled Type 2 Diabetes Patients In Malaysia - A Study Protocol

Abstract Objectives Bariatric Surgery is a major breakthrough in diabetes care. Complete remission is attainable in a great percentage of patients. However, there is slow progress in this procedure in Malaysia. With the overwhelming rate of obesity and diabetes in the country, the potential advantage of this treatment modality is underestimated. Conventional diabetes care only controls 22% of the diabetics and healthcare expenditure has ballooned due to complications costs amounting to at least RM 2 billion in a year eating up 10% of the government's budget on healthcare. Furthermore, this burden will increase in the next decades as diabetes is predicted to increase by 69% by 2030. While this procedure is beneficial, it is an expensive intervention with risks of complications. This raises the question of whether bariatric surgery is cost-effective in the context of this country? Evidence must be available to decision-makers weighing the risk-benefit ratio of the procedure. This study aims to assess the clinical effectiveness and cost-effectiveness of bariatric surgery in managing obesity among the Malaysian population. It will specifically investigate the short term and long-term effects of the procedure investigating anthropometric and metabolic disease blood indicator changes while assessing direct, indirect costs, QALYs gained and complications associated with the procedure. Methods We will review charts of all patients who have undergone bariatric surgery procedures from 2014 to 2016 in HUKM, Department of Surgery and in Andrea Bariatric Surgery Clinic. We will look at their weight, BMI, and some blood parameter results before and after surgery one-year post-surgery for the short-term effect and 3–5 years post-surgery for the long-term effect. We will also assess the mortality risks and complications of the procedures. Study Population: All patients who underwent Bariatric Surgery procedures from 2014–206 in HUKM and in Andrea Bariatric Surgery ClinicStudy Site/Location: HUKM, Department of Surgery &amp; Andrea Bariatric Surgery Clinic Results N/A - Study Protocol Conclusions The result of this study can contribute to the decision making of patients, doctors, and Health Insurance Companies in Malaysia Funding Sources Center for Research Management, Taylor's University.

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.

A104 Long-Term Cost-Effectiveness of Bariatric Surgery vs Conventional Treatment in Swedish Obese Subjects By Baseline Glycemic Status

A104 Long-Term Cost-Effectiveness of Bariatric Surgery vs Conventional Treatment in Swedish Obese Subjects By Baseline Glycemic Status

Cost-effectiveness of Bariatric Surgery for People with Morbid Obesity in South Korea.

This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity. The target cohort was people with morbid obesity, defined as BMI of ≥ 35kg/m2, or obese people with BMI of 30-34.9kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20years, a cycle length of 1year, a time horizon of 80years, and a 5% discount rate were applied for the base case from the healthcare system perspective. In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0-37.4kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS. BS at BMI of > 30kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.

Economics and Policy in Bariatric Surgery.

The purpose of this review is to provide current synthesis of the evidence on the cost-effectiveness of bariatric surgery for persons with diabetes. Virtually, every study that has evaluated the cost-effectiveness of bariatric surgery for persons who are obese and have type 2 diabetes has concluded that surgery is cost-effective. A few studies outside the USA found that surgery is cost-saving. Currently, most but not all US insurers cover bariatric surgery in persons with type 2 diabetes and BMI ≥ 35kg/m2. Bariatric surgery is a cost-effective treatment for persons with type 2 diabetes and BMI ≥ 35kg/m2. There is interest in extending surgery to persons with diabetes and lower BMI; the cost-effectiveness of treating these individuals with bariatric surgery should be explored. Despite the potential benefits, not all obese or overweight persons with diabetes will choose surgery.

Cost-Effectiveness Evaluation of Bariatric Surgery for Morbidly Obese with Diabetes Patients in Thailand.

Background Bariatric surgery is a choice for treatment in morbidly obese patients with type 2 diabetes mellitus (DM type 2) who have inadequate diabetes control with only medical treatment. However, bariatric surgery requires highly sophisticated equipment, and thus the cost of surgery seems to be very high following the procedure compared with the cost of conventional diabetes care. This raises the question of whether bariatric surgery is cost-effective for morbidly obese people with diabetes in Thailand. Objective To perform a cost-effectiveness evaluation of bariatric surgery compared with ordinary treatment for diabetes control in morbidly obese DM type 2 patients in Thailand. Methods Cost-effectiveness study was conducted, using a combination of decision tree and Markov model in analysis. Treatment outcomes and healthcare costs were incurred by data from literature review and retrospective cohort in King Chulalongkorn Memorial Hospital from September 2009 to March 2016 for the conventional and bariatric surgery group, respectively. One-way sensitivity was used for analysis of the robustness of the model. Cost-effectiveness was assessed by calculating incremental cost-effectiveness ratios (ICERs). Monetary benefits at a threshold of 150,000 to 200,000 Thai baht (THB) per quality-adjusted life-year (QALY) based on the Thailand gross domestic products (GDP) value was regarded as cost-effectiveness of bariatric surgery. Results Bariatric surgery significantly improves the clinical outcome including long-term diabetes remission rate, hemoglobin A1C, and body mass index (BMI). The incremental cost per QALY of bariatric surgery compared with the medication control is 26,907.76 THB/QALY which can consider bariatric surgery as a cost-effective option. Conclusions Use of bariatric surgery in morbidly obese with DM type 2 patients is a cost-effective strategy in Thailand's context.

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

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.

EE3 - The Cost-Effectiveness of Bariatric Surgery in Germany, France, Italy and the United Kingdom

EE3 - The Cost-Effectiveness of Bariatric Surgery in Germany, France, Italy and the United Kingdom

The Effect of Bariatric Surgery on Mobility, Health-Related Quality of Life, Healthcare Resource Utilization, and Employment Status.

A sub-study of the Ontario Bariatric Registry was conducted to evaluate the impact of bariatric surgery on mobility, health-related quality of life (HRQoL), healthcare resource utilization (HRU), and employment status. The 1-year change in mobility following bariatric surgery was evaluated using the mobility domain of the EuroQOL-5D-5L (EQ-5D-5L), which was self-administered at baseline and 1year after bariatric surgery along with questions on HRU. Another questionnaire was used to document employment status at time of surgery and 1year later. The population included 304 individuals (mean age=46years; 85% female). At baseline, 68% of participants had some problems in walking compared to 14% at 1year following surgery (p<0.001). The EQ-5D-5L health utility score increased from 0.73 to 0.90 (p<0.001). The number of hospitalizations increased significantly before and after surgery (p=0.021). Of the 304 study participants, 138 completed the questionnaire and responses indicated that more individuals reported a change in their employment status within 1year following surgery (26%) compared to 1year prior to the surgery (9%) (p<0.001). Within the limitations of this study, there is a suggestion that bariatric surgery has a major impact on mobility and HRQoL. More research is warranted to understand the benefits, costs, and cost-effectiveness of bariatric surgery in Canada.

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

BackgroundBariatric surgery is known to be an effective treatment for extreme obesity but access to these procedures is currently limited.ObjectiveThis study aimed to evaluate the costs and outcomes of increasing access to bariatric surgery for severe and morbid obesity.Design and methodsPrimary care electronic health records from the UK Clinical Practice Research Datalink were analysed for 3045 participants who received bariatric surgery and 247,537 general population controls. The cost-effectiveness of bariatric surgery was evaluated in severe and morbid obesity through a probabilistic Markov model populated with empirical data from electronic health records.ResultsIn participants who did not undergo bariatric surgery, the probability of participants with morbid obesity attaining normal body weight was 1 in 1290 annually for men and 1 in 677 for women. Costs of health-care utilisation increased with body mass index category but obesity-related physical and psychological comorbidities were the main drivers of health-care costs. In a cohort of 3045 adult obese patients with first bariatric surgery procedures between 2002 and 2014, bariatric surgery procedure rates were greatest among those aged 35–54 years, with a peak of 37 procedures per 100,000 population per year in women and 10 per 100,000 per year in men. During 7 years of follow-up, the incidence of diabetes diagnosis was 28.2 [95% confidence interval (CI) 24.4 to 32.7] per 1000 person-years in controls and 5.7 (95% CI 4.2 to 7.8) per 1000 person-years in bariatric surgery patients (adjusted hazard ratio was 0.20, 95% CI 0.13 to 0.30;p &lt; 0.0001). In 826 obese participants with type 2 diabetes mellitus who received bariatric surgery, the relative rate of diabetes remission, compared with controls, was 5.97 (95% CI 4.86 to 7.33;p &lt; 0.001). There was a slight reduction in depression in the first 3 years following bariatric surgery that was not maintained. Incremental lifetime costs associated with bariatric surgery were £15,258 (95% CI £15,184 to £15,330), including costs associated with bariatric surgical procedures of £9164 per participant. Incremental quality-adjusted life-years (QALYs) were 2.142 (95% CI 2.031 to 2.256) per participant. The estimated cost per QALY gained was £7129 (95% CI £6775 to £7506). Estimates were similar across gender, age and deprivation subgroups.LimitationsIntervention effects were derived from a randomised trial with generally short follow-up and non-randomised studies of longer duration.ConclusionsBariatric surgery is associated with increased immediate and long-term health-care costs but these are exceeded by expected health benefits to obese individuals with reduced onset of new diabetes, remission of existing diabetes and lower mortality. Diverse obese individuals have clear capacity to benefit from bariatric surgery at acceptable cost.Future workFuture research should evaluate longer-term outcomes of currently used procedures, and ways of delivering these more efficiently and safely.FundingThe National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Martin C Gulliford and A Toby Prevost were supported by the NIHR Biomedical Research Centre at Guy’s and St Thomas’ Hospitals. Peter Littlejohns was supported by the South London Collaboration for Leadership in Applied Health Research and Care. The funders did not engage in the design, conduct or reporting of the research.

The Cost-Effectiveness Of Bariatric Surgery In Germany

The Cost-Effectiveness Of Bariatric Surgery In Germany

Cost-effectiveness of Bariatric Surgery: Increasing the Economic Viability of the Most Effective Treatment for Type II Diabetes Mellitus

There has been considerable debate on the cost-effectiveness of bariatric surgery within larger population groups. Despite the recognition that morbid obesity and its comorbidities are best treated surgically, insurance coverage is not universally available. One of the more costly comorbidities of obesity is Type II diabetes mellitus (T2DM). We propose a model that demonstrates the cost-effectiveness of increasing the number of bariatric surgical operations performed on patients with T2DM in the United States. We applied published population cost estimates (2012) for medical care of T2DM to a retrospective cohort of morbidly obese patients in South Carolina. We compared differences in 10-year medical costs between those having bariatric surgery and controls. Resolution of T2DM in the bariatric cohort was assumed to be 40 per cent. Considering only the direct medical costs of T2DM, the 10-year aggregate cost savings compared with a control group is $2.7 million/1000 patients; the total (direct and indirect) cost savings is $5.4 million/1000 patients. When considering resolution of T2DM alone, increasing the number of bariatric operations for a given population leads to a substantial cost savings over a 10-year period. This study adds to the growing body of evidence suggesting that bariatric surgery is a cost-effective means of caring for the obese patient.

The cost of bariatric medical tourism on the Canadian healthcare system

BackgroundMedical tourists are defined as individuals who intentionally travel from their home province/country to receive medical care. Minimal literature exists on the cost of postoperative care and complications for medical tourists. The costs associated with these patients were reviewed. MethodsBetween February 2009 and June 2013, 62 patients were determined to be medical tourists. Patients were included if their initial surgery was performed between January 2003 and June 2013. A chart review was performed to identify intervention costs sustained upon their return. ResultsConservatively, the costs of length of stay (n = 657, $1,433,673.00), operative procedures (n = 110, $148,924.30), investigations (n = 700, $214,499.06), blood work (n = 357, $19,656.90), and health professionals' time (n = 76, $17,414.87) were summated to the total cost of $1.8 million CAD. ConclusionsThe absolute denominator of patients who go abroad for bariatric surgery is unknown. Despite this, a substantial cost is incurred because of medical tourism. Future investigations will analyze the cost effectiveness of bariatric surgery conducted abroad compared with local treatment.