BACKGROUND: Obesity is a growing public health problem in industrialized countries and is directly and indirectly responsible for almost 10% of all health expenditures. Bariatric surgery is the best available treatment, however, associated with important economical expenditures. So, cost-effectiveness analysis of the available surgical options is paramount. METHODS: We developed a Markov model for three different strategies: best medical management, gastric band, and gastric bypass. The Markov model was constructed to allow for the evaluation of the impact of several obesity-related comorbidities. The results were derived for a representative population of morbidly obese patients, and subgroup analyses were performed for patients without comorbidities, patients with diabetes mellitus, different age, and body mass index (BMI) groups. Cost-effectiveness analysis was performed accounting for lifetime costs and from a societal perspective. RESULTS: Gastric bypass is a dominant strategy, rendering a significant decrease in lifetime costs and increase in quality-adjusted life years (QALYs). Comparing with the best medical management, in the global population of patients with a BMI of > 35 kg/m2, gastric bypass renders 1.9 extra QALYs and saves on average 13,244€ per patient. Younger patients, patients with a BMI between 40 and 50 kg/m2, and patients without obesity-related diseases are the ones with a bigger benefit in terms of cost effectiveness. CONCLUSIONS: Gastric bypass surgery increases quality-adjusted survival and saves resources to health systems. As such, it can be an important process to control the ever-increasing health expenditure.
BACKGROUND:Obesity is a growing public health problem in industrialized countries and is directly and indirectly responsible for almost 10% of all health expenditures. Bariatric surgery is the best available treatment, however, associated with important economical expenditures. So, cost-effectiveness analysis of the available surgical options is paramount. METHODS: We developed a Markov model for three different strategies: best medical management, gastric band, and gastric bypass. The Markov model was constructed to allow for the evaluation of the impact of several obesity-related comorbidities. The results were derived for a representative population of morbidly obesepatients, and subgroup analyses were performed for patients without comorbidities, patients with diabetes mellitus, different age, and body mass index (BMI) groups. Cost-effectiveness analysis was performed accounting for lifetime costs and from a societal perspective. RESULTS: Gastric bypass is a dominant strategy, rendering a significant decrease in lifetime costs and increase in quality-adjusted life years (QALYs). Comparing with the best medical management, in the global population of patients with a BMI of > 35 kg/m2, gastric bypass renders 1.9 extra QALYs and saves on average 13,244€ per patient. Younger patients, patients with a BMI between 40 and 50 kg/m2, and patients without obesity-related diseases are the ones with a bigger benefit in terms of cost effectiveness. CONCLUSIONS: Gastric bypass surgery increases quality-adjusted survival and saves resources to health systems. As such, it can be an important process to control the ever-increasing health expenditure.
Authors: Ali H Mokdad; Earl S Ford; Barbara A Bowman; William H Dietz; Frank Vinicor; Virginia S Bales; James S Marks Journal: JAMA Date: 2003-01-01 Impact factor: 56.272
Authors: Delphine De Smedt; Katrien De Cocker; Lieven Annemans; Ilse De Bourdeaudhuij; Greet Cardon Journal: Public Health Nutr Date: 2011-08-23 Impact factor: 4.022
Authors: Nicolas V Christou; John S Sampalis; Moishe Liberman; Didier Look; Stephane Auger; Alexander P H McLean; Lloyd D MacLean Journal: Ann Surg Date: 2004-09 Impact factor: 12.969
Authors: Raj S Padwal; Sumit R Majumdar; Scott Klarenbach; Dan W Birch; Shahzeer Karmali; Linda McCargar; Konrad Fassbender; Arya M Sharma Journal: BMC Health Serv Res Date: 2010-10-08 Impact factor: 2.655
Authors: Amarpreet S Chawla; Chia-Wen Hsiao; Martha C Romney; Ricardo Cohen; Francesco Rubino; Philip Schauer; Pierre Cremieux Journal: Pharmacoeconomics Date: 2015-07 Impact factor: 4.981
Authors: Marcello Lucchese; Oleg Borisenko; Lorenzo Giovanni Mantovani; Paolo Angelo Cortesi; Giancarlo Cesana; Daniel Adam; Elisabeth Burdukova; Vasily Lukyanov; Nicola Di Lorenzo Journal: Obes Facts Date: 2017-06-10 Impact factor: 3.942