Robbie James1, Ryan Ishmael Salton2, Joshua Michael Byrnes1, Paul Anthony Scuffham3. 1. Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia. 2. Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; City University, London, United Kingdom. 3. Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia. Electronic address: p.scuffham@griffith.edu.au.
Abstract
BACKGROUND: The uptake of bariatric surgery in Australia has been hampered by the lack of funding and lack of evidence on relative value for money. OBJECTIVES: To determine the cost-effectiveness of adjustable gastric banding (AGB), Roux-En-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) versus usual care (UC). SETTING: Perspective of the Australian public healthcare system. METHODS: A Markov model was constructed to simulate the costs and outcomes for 4 approaches to managing obesity. The base-case was a 30-year-old Australian female with a body-mass index>35. Subgroup analysis was conducted to account for the effect of diabetes as well as various differences in cohort characteristics. Uncertainty was characterised by one-way and probabilistic sensitivity analyses. RESULTS: All bariatric surgeries were effective. The incremental cost-effectiveness ratios were similar at $24,454 for AGB, $22,645 for RYGB, and $27,523 for SG, compared with UC. At a willingness to pay threshold of $70,000 per quality-adjusted life year, the probabilities of being cost-effective were 64%, 75%, and 71% for AGB, RYGB, and SG, respectively. Subgroup analysis showed that bariatric procedures are less cost-effective for older cohorts. For those with diabetes, all the procedures were dominant in comparison with UC. CONCLUSION: This model shows that all bariatric procedures are a cost-effective treatment for the management of obese patients. When given to a subgroup with diabetes, bariatric interventions become cost-saving.
BACKGROUND: The uptake of bariatric surgery in Australia has been hampered by the lack of funding and lack of evidence on relative value for money. OBJECTIVES: To determine the cost-effectiveness of adjustable gastric banding (AGB), Roux-En-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) versus usual care (UC). SETTING: Perspective of the Australian public healthcare system. METHODS: A Markov model was constructed to simulate the costs and outcomes for 4 approaches to managing obesity. The base-case was a 30-year-old Australian female with a body-mass index>35. Subgroup analysis was conducted to account for the effect of diabetes as well as various differences in cohort characteristics. Uncertainty was characterised by one-way and probabilistic sensitivity analyses. RESULTS: All bariatric surgeries were effective. The incremental cost-effectiveness ratios were similar at $24,454 for AGB, $22,645 for RYGB, and $27,523 for SG, compared with UC. At a willingness to pay threshold of $70,000 per quality-adjusted life year, the probabilities of being cost-effective were 64%, 75%, and 71% for AGB, RYGB, and SG, respectively. Subgroup analysis showed that bariatric procedures are less cost-effective for older cohorts. For those with diabetes, all the procedures were dominant in comparison with UC. CONCLUSION: This model shows that all bariatric procedures are a cost-effective treatment for the management of obesepatients. When given to a subgroup with diabetes, bariatric interventions become cost-saving.
Authors: Karen Jordan; Christopher G Fawsitt; Paul G Carty; Barbara Clyne; Conor Teljeur; Patricia Harrington; Mairin Ryan Journal: Eur J Health Econ Date: 2022-07-22
Authors: Julie A Campbell; Martin Hensher; Daniel Davies; Matthew Green; Barry Hagan; Ian Jordan; Alison Venn; Alexandr Kuzminov; Amanda Neil; Stephen Wilkinson; Andrew J Palmer Journal: Pharmacoecon Open Date: 2019-12