Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records
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Published version
Author(s)
Type
Journal Article
Abstract
Objectives To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. Methods A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. Results In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18–£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123–8,502). Incremental QALYs will increase by 2,142 (range 2,032–2,256). The estimated cost per QALY gained is £7,129 (range £6,775–£7,506). Net monetary benefits will be £49.02 million (range £45.72–£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Conclusions Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals.
Date Issued
2016-10-21
Online Publication Date
2016-10-21
2017-12-07T14:19:55Z
Date Acceptance
2016-10-21
ISSN
1098-3015
Publisher
Elsevier
Start Page
85
End Page
92
Journal / Book Title
Value in Health
Volume
20
Issue
1
Copyright Statement
Copyright & 2017, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Subjects
Social Sciences
Science & Technology
Life Sciences & Biomedicine
Economics
Health Care Sciences & Services
Health Policy & Services
Business & Economics
bariatric surgery
cost-effectiveness analysis
diabetes mellitus
obesity
SWEDISH OBESE SUBJECTS
BODY-MASS INDEX
CONTROLLED INTERVENTION
MATCHED COHORT
CARE COSTS
METAANALYSIS
ASSOCIATION
DEPRESSION
MORTALITY
IMPACT
Adult
Age Factors
Aged
Bariatric Surgery
Comorbidity
Cost-Benefit Analysis
Depression
Diabetes Mellitus
Electronic Health Records
Female
Health Expenditures
Health Services Accessibility
Humans
Male
Markov Chains
Middle Aged
Models, Econometric
Obesity
Obesity, Morbid
Quality-Adjusted Life Years
Sex Factors
Socioeconomic Factors
United Kingdom
Young Adult
1117 Public Health And Health Services
1402 Applied Economics
Publication Status
Published