Bariatric surgery seems to be cost-effective over ten-year and lifetime horizons in high income countries (HICs) for both mixed obesity group (with/without diabetes mellitus (DM)) and obesity with diabetes group, according to a meta-analysis by researchers from Mahidol University, Bangkok, Thailand. Using incremental net monetary benefit (INB), which is the difference in net monetary benefit between the new intervention and the standard intervention, they found pooled INB for bariatric surgery vs usual care in HICs was estimated to be between $81,000 and $102,000 over the lifetime horizon ($ international dollars). The outcomes were featured in the paper, ‘Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences’, published in Obesity Surgery.
The researchers noted that there have been few meta-analyses that have pooled INBs and as there is still some debated as to the cost-effectiveness of bariatric surgery, they conducted a meta-analysis which systematically reviewed and pooled INBs of bariatric surgery as compared with usual care among patients with obesity. They examined whether bariatric surgery was cost-effective in particular type of patients (obese with DM) and determined which specific procedures of bariatric surgery (eg open or laparoscopic surgeries of adjustable gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and a mix of these bariatric surgeries (BS)) were cost-effective when compared with usual care (e.g., pharmacotherapy and/or lifestyle modification).
Outcomes
In total, 28 studies were included, 20 (71.4%) were conducted in mixed obesity group (i.e., with/without diabetes) and eight were conducted in obesity with diabetes group. All studies, except for one, were conducted in obese patients whose BMIs were >35 kg/m2. The three most common interventions were AGB (n=15, 53.6%), RYGB (n=20, 71.4%) and SG (n=11, 39.3%).
For mixed obesity group, bariatric surgery was found to be cost-effective in all except for three studies, at two-, five- and ten-years. For obesity with diabetes group, all studies revealed that bariatric surgery was cost-effective.
The INBs of overall bariatric surgery versus usual care among mixed obesity group under payer perspective varied across 11 studies with a pooled INB over lifetime horizon of $101,897.96 ($79,390.93-$124,404.99). Subgroup analysis showed that that AGB, SG and mixed types of BS, but not RYGB, were significantly cost-effective vs usual care. The INBs of bariatric surgery among mixed obesity group over a ten-year period were also varied across seven studies, with a pooled INB of $53,063.69 ($42,647.96-$63,479.43).
The INBs of bariatric surgery among obesity with diabetes group were pooled from seven studies and the pooled INB was $80,826.28 ($32,500.75-$129,151.81), indicating that bariatric surgery was cost-effective vs usual care.
Of the four studies from Upper-Middle-Income Countries (UMICs), for mixed group obesity group, the researchers noted that the evidence was inconclusive. However, all studies conducted among obesity with diabetes group revealed that bariatric surgery was cost-effective with the INBs ranging from $4,015.28-$40,867.97. Although, as the studies had varying time horizons, the INBs were not pooled.
“In conclusion, our findings indicated that bariatric surgery seems to be cost-effective over ten-year and lifetime horizons in HICs for both mixed obesity group (i.e., with/without diabetes) and obesity with diabetes group,” the authors concluded. “The pooled INB for bariatric surgery as compared with usual care in HICs was estimated to be between US$81,000 and US$102,000 over the lifetime horizon. For UMICs, bariatric surgery seemed to be cost-effective as compared with usual care among obesity with diabetes group with the INBs ranging from US$4,000 to US$41,000.”
Further information
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