Expanding the capacity of bariatric and metabolic surgery (BMS) capacity in England beyond a small proportion of the eligible population will likely be ‘challenging’ due to the significant upfront economic investment and additional requirement of personnel and infrastructure, according to UK researchers.
The investigators noted that the Health Survey of England 2019 indicated that 28% of adults were living with obesity and 3.3% were living with severe obesity (BMI≥40 kg/m2). Furthermore, by 2060, the projected prevalence of UK adults who are living with overweight or obesity will be 84.8%. In addition, the current cost of obesity and associated complications for the National Health Service (NHS) is £6.1 billion (4% of the total NHS spending on health services in 2022/20238), and for society £27 billion, which is projected to increase 4–5 fold by 2050.
Given that BMS is the most effective treatment for people living with obesity, the researchers wanted to assess the feasibility of scaling up BMS, particularly with a focus on estimating the investment and resources required.
The authors estimated the total costs at current capacity and also over a 20-year time frame under each of the following BMS scale-up strategies:
Strategy 1: maximising NHS capacity, which involved pushing the current capacity to its maximum potential given the current resources and personnel without additional infrastructure or personnel included during scale-up
Strategy 2: maximising current NHS and private sector capacity: in addition to maximising NHS capacity, this strategy involved using a proportion of private sector capacity without additional infrastructure/personnel
Strategy 3: adding infrastructure to increase the current NHS capacity: in addition to maximising NHS capacity given current resources, this strategy involved building more facilities and adding personnel to increase the current capacity, both of which were assumed to be exclusively dedicated to BMS
For their analysis, the prevalent and annual incident targeted eligible population sizes were estimated at 347,885 and 10,326, respectively. Therefore, the total targeted eligible population size over 20 years was estimated to be 554,405. However, the current capacity in NHS England for BMS provision were estimated to be 140,220 (revision surgeries: 2,474) over 20 years, which equates to 7,011 BMS per year. The associated annual and overall costs were £70.6 million and £1.4 billion, respectively.
The researchers found that based on the model estimates:
Strategy 1: The economic investment required to scale up BMS capacity by 12.5% to maximise the current NHS England capacity (without scaling up the infrastructure and personnel) was estimated to require an incremental cost of £13.7 million/year, with a capacity to conduct an additional 17K operations over 20 years, reducing the backlog to approximately 407K over a 20-year time horizon.
Strategy 2: To maximise BMS use in NHS and private sectors, increased the capacity by an additional 91K operations over 20 years and increased the total annual cost by £52.9 million, which reduced the backlog to 332K operations.
Strategy 3: Maximising NHS capacity, along with the addition of infrastructure and personnel, aimed to provide BMS to the whole target population and resolve the backlog, which supported an additional 417K surgeries over 20 years with an additional budget of £248.8 million/year.
The total 20-year incremental costs to NHS England were estimated at £5 billion, including £4.3 billion for procedures, £363 million for infrastructure and £247 million for 4081 additional personnel.
“In order to meet the demands of the increasing prevalence of obesity and its complications, multiple treatment approaches will be needed in addition to BMS, and scalable treatment options will be required,” the authors concluded.
The findings were reported in the paper, 'Assessing economic investment required to scale up bariatric surgery capacity in England: a health economic modelling analysis', published in BMJ Open. To access this paper, please click here
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