COST EFFECTIVENESS OF BARIATRIC SURGERY FOR MORBID OBESITY IN USA

OBJECTIVES: To evaluate the cost-effectiveness of bariatric surgery using three different techniques - (Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), Laparoscopic Adjustable Gastric Banding (LAGB) and Laparoscopic Sleeve Gastrectomy (LSG)) - as treatment for morbid obesity in USA. METHODS: A microsimulation model was developed over a lifetime horizon to simulate weight change, cardiometabolic comorbidities status, health consequences and costs of bariatric surgery for morbid obesity. Incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained were used in the model. Surgical effectiveness was derived from observational studies and randomized clinical trials. Surgical complication rates, adverse events, the remission of cardiometabolic comorbidities, mortality rates, costs, utilities and other model parameters were estimated from publicly available databases and published literature. The discount rate for costs (2016 US dollars) and QALYs was 3%. RESULTS: Under conservative assumptions, all techniques enhanced health outcomes at lower cost (cost saving) compared to no surgery for patients with cardiometabolic comorbidities (type 2 diabetes, hypertension and or dyslipide-mia). However, bariatric surgery was not cost saving for patients without comorbidities. LRYGB is cost effective with higher QALYs (16.44) and lower cost ($168,927) than LSG (15.74 QALY; $187,587), LAGB (15.08 QALY; $200,539) and no surgery (13.43 QALY; $251,917) for patients with cardiometabolic comorbidities. In addition, LRYGB is cost effective for patients without comorbidities (17.53 QALY; $137,879) compared with LSG (17.16 QALY; $136,041), LAGB (16.68 QALY; $130,971) and no surgery (15.15 QALY; $117,367), having the maximum net monetary benefit (NMB) over a willingness to pay (WTP) range form $0-250,000. Sensitivity analysis showed robustness to reasonable variation in overall model parameters. CONCLUSIONS: All types of bariatric surgeries showed significant weight loss compared to no surgery. LRYGB is the optimal bariatric technique, being cost effective compared with LSG, LAGB and no surgery options.