Bariatric Surgery for Morbidly Obese Patients: Cost

Title: Bariatric Surgery for Morbidly Obese Patients: Cost-Effectiveness
Date: 2 November 2007
Research question:
What is the cost-effectiveness of bariatric surgery for morbidly obese patients?
Methods:
A limited literature search was conducted on key health technology assessment resources,
including PubMed, the Cochrane Library (Issue 4, 2007), University of York Centre for Reviews
and Dissemination (CRD) databases, ECRI’s HTAIS, EuroScan, international HTA agencies,
and a focused Internet search. Results include articles published between 2002 and the
present, and are limited to English language publications only. Filters were applied to limit the
retrieval to economic studies. Internet links and abstracts are provided, where available.
Results:
The results are listed below and additional references of interest are included in the attached
appendix.
Health technology assessments
1. Treadwell J, Sun F, Bruening W, Reston J, Noble M, Schoelles K, Erinoff E. Health
technology assessment: bariatric surgery for pediatric patients. Olympia (WA): Washington
State Health Care Authority; 2007. Available:
http://www.hta.hca.wa.gov/docs/bariatric_pediatric.pdf (accessed 2007 Oct 26).
Disclaimer: The Health Technology Inquiry Service (HTIS) is an information service for those involved in planning and providing
health care in Canada. HTIS responses are based on a limited literature search and are not comprehensive, systematic reviews.
The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts
within the time allowed. HTIS responses should be considered along with other types of information and health care considerations.
The information included in this response is not intended to replace professional medical advice, nor should it be construed as a
recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality
evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for
which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation
of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect.
CADTH is not liable for any loss or damages resulting from use of the information in the report.
Copyright: This report contains CADTH copyright material and may contain material in which a third party owns copyright. This
report may be used for the purposes of research or private study only. It may not be copied, posted on a web site,
redistributed by email or stored on an electronic system without the prior written permission of CADTH or applicable copyright
owner.
Links: This report may contain links to other information on available on the websites of third parties on the Internet. CADTH does
not have control over the content of such sites. Use of third party sites is governed by the owners’ own terms and conditions.
2. Hassen-Khodja R, Lance J-MR. Surgical treatment of morbid obesity: an update. Montreal:
Agence d’Evaluation des Technologies et des Modes d’Intervention en Santé
(AETMIS);2006. Available: http://www.aetmis.gouv.qc.ca/site/aid=611.phtml (accessed 2007
Oct 26).
Note: see “Economic outcomes” p. 35
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=32005001206
(accessed 2007 Nov 2).
3. Ontario Health Technology Advisory Committee, Medical Advisory Secretariat. Bariatric
surgery. Toronto: Ontario Ministry of Health and Long-Term Care; 2005 Available:
http://www.health.gov.on.ca/english/providers/program/ohtac/tech/reviews/pdf/rev_baria_01
0105.pdf
Note: see “Economic analysis” p. 85
4. ECRI. Laparoscopic bariatric surgery for morbid obesity. [Windows on Medical Technology
no 126]. Plymouth Meeting (PA): ECRI; 2005.
Note: see p. 30 for information on cost
5. Chen J, McGregor M. The gastric banding procedure: an evaluation. Montreal: Technology
Assessment Unit of the McGill University Health Centre (MUHC); 2004. Available:
http://www.mcgill.ca/files/tau/Gastric_Banding_FINAL_Apr27.pdf (accessed 2007 Oct 24).
Note: see “Costs” p. 14
CRD structured abstract available:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=32004000644
(accessed 2007 Nov 2).
6. ECRI. Bariatric surgery for obesity. Plymouth Meeting (PA): ECRI; 2004.
Note: see p. 128 for economic considerations.
7. Clegg AJ, Colquitt J, Sidhu MK, Royle P, Loveman E, Walker A. The clinical effectiveness
and cost-effectiveness of surgery for people with morbid obesity: a systematic review and
economic evaluation. [NICE Technology Assessment Report]. Southhampton (UK): NIHR
Health Technology Assessment Programme; 2002. Available:
http://www.hta.nhsweb.nhs.uk/project/1245.asp (accessed 2007 Oct 26).
Systematic reviews and meta-analyses
1. Weaver K. Bariatric surgery: MedTAP report. Salem (OR): Oregon Health Resources
Commission; 2006. Available:
http://www.oregon.gov/DAS/OHPPR/HRC/docs/OBESITY_BariatricSurgeryReport.pdf
(accessed 2007 Oct 26).
Note: see “What is the cost-effectiveness of bariatric surgery measured in $/QALY (quality
adjusted years) or by other methods?” p. 17
2. Medical Services Advisory Committee. Laparoscopic adjustable gastric banding for morbid
obesity. Canberra: Medical Services Advisory Committee; 2003. Available:
http://www.msac.gov.au/internet/msac/publishing.nsf/Content/ref14-1/$FILE/msacref14.pdf
Note: see “What are the economic considerations” p. 69
Bariatric Surgery for Morbidly Obese Patients
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Economic analyses and cost information
1. Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of
obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg
2006;16(11):1488-503. PubMed: PM17132416
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22006002364 (accessed 2007 Nov
2).
2. Finkelstein EA, Brown DS. A cost-benefit simulation model of coverage for bariatric surgery
among full-time employees. Am J Manag Care 2005;11(10):641-6. PubMed: PM16232005
3. Livingston EH. Hospital costs associated with bariatric procedures in the United States. Am J
Surg 2005;190(5):816-20. PubMed: PM16226964
4. Paxton JH, Matthews JB. The cost effectiveness of laparoscopic versus open gastric bypass
surgery. Obes Surg 2005;15(1):24-34. PubMed: PM15760496
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22005000303 (accessed 2007 Nov
2).
5. Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med
2002;113(6):491-8. PubMed: PM12427499
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22002002008 (accessed 2007 Nov
2).
Randomized controlled trials
1. van Mastrigt GA, van Dielen FM, Severens JL, Voss GB, Greve JW. One-year costeffectiveness of surgical treatment of morbid obesity: vertical banded gastroplasty versus LapBand. Obes Surg 2006;16(1):75-84. PubMed: PM16417762
Observational studies
1. Hawkins SC, Osborne A, Finlay IG, Alagaratnam S, Edmond JR, Welbourn R. Paid work
increases and state benefit claims decrease after bariatric surgery. Obes Surg 2007;17(4):4347. PubMed: PM17608252
2. Gorman RS, Stern DL, Inclan DV, Presutti RJ, Swain JM, Hentz JG. Outcomes, health status,
and medical resource utilization after bariatric surgery. Compr Ther 2006;32(1):34-8. PubMed:
PM16785580
3. Nguyen NT, Varela JE, Sabio A, Naim J, Stamos M, Wilson SE. Reduction in prescription
medication costs after laparoscopic gastric bypass. Am Surg 2006;72(10):853-6. PubMed:
PM17058720
Bariatric Surgery for Morbidly Obese Patients
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4. Katopodi T, Katostaras T. The weight reduction operation of choice: mason vs gastric bypass.
a comparative study. Review of Clinical Pharmacology and Pharmacokinetics International
Edition 2005;19(3):155-8.
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=22006000195 (accessed 2007 Nov
2).
5. Gould JC, Garren MJ, Starling JR. Laparoscopic gastric bypass results in decreased
prescription medication costs within 6 months. J Gastrointest Surg 2004;8(8):983-7. PubMed:
PM15585385.
CRD structured abstract available from:
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?View=Full&ID=22005008444 (accessed
2007 Nov 2).
6. Monk JS, Jr., Dia NN, Stehr W. Pharmaceutical savings after gastric bypass surgery. Obes
Surg 2004;14(1):13-5. PubMed: PM14980027
7. Potteiger CE, Paragi PR, Inverso NA, Still C, Reed MJ, Strodel W, et al. Bariatric surgery:
shedding the monetary weight of prescription costs in the managed care arena. Obes Surg
2004;14(6):725-30. PubMed: PM15318973
8. Sampalis JS, Liberman M, Auger S, Christou NV. The impact of weight reduction surgery on
health-care costs in morbidly obese patients. Obes Surg 2004;14(7):939-47. PubMed:
PM15329183
9. Snow LL, Weinstein LS, Hannon JK, Lane DR, Ringold FG, Hansen PA, et al. The effect of
Roux-en-Y gastric bypass on prescription drug costs. Obes Surg 2004;14(8):1031-5. PubMed:
PM15479590
10. Fang J. The cost-effectiveness of bariatric surgery. Am J Gastroenterol 2003;98(9):2097-8.
PubMed: PM14499794
11. Gallagher SF, Banasiak M, Gonzalvo JP, Paoli DP, Allwood J, Morris D, et al. The impact of
bariatric surgery on the Veterans Administration healthcare system: a cost analysis. Obes
Surg 2003;13(2):245-8. PubMed: PM12740132
12. Agren G, Narbro K, Jonsson E, Naslund I, Sjostrom L, Peltonen M. Cost of in-patient care
over 7 years among surgically and conventionally treated obese patients. Obes Res
2002;10(12):1276-83. PubMed: PM12490672
13. Narbro K, Agren G, Jonsson E, Naslund I, Sjostrom L, Peltonen M. Pharmaceutical costs in
obese individuals: comparison with a randomly selected population sample and long-term
changes after conventional and surgical treatment: the SOS intervention study. Arch Intern
Med 2002;162(18):2061-9. PubMed: PM12374514
Bariatric Surgery for Morbidly Obese Patients
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Guidelines and recommendations
1. National Institute for Health and Clinical Excellence (NICE). Obesity. [guideline no 43].
London (UK): NICE; 2006. Available: http://guidance.nice.org.uk/CG43/guidance (accessed
2007 Oct 26).
Note: see section 6, “Health economics: evidence statements and reviews”
2. Scottish Executive Health Department, Scottish Medical and Scientific Advisory Committee.
Review of bariatric surgery services in Scotland: weight loss surgery for adults who are
severely obese. Edinburgh: Scottish Executive; 2004.
http://www.scotland.gov.uk/Resource/Doc/35596/0012569.pdf (accessed 2007 Oct 26).
Note: see “Economic considerations” section
Prepared by:
Karen Cimon, Research Assistant
Kelly Farrah, MLIS, Information Specialist
Health Technology Inquiry Service
Email: [email protected]
Tel: 1-866-898-8439
Bariatric Surgery for Morbidly Obese Patients
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Appendix – Further information:
Review articles
1. Bachman KH. Obesity, weight management, and health care costs: a primer. Dis Manag
2007;10(3):129-37. PubMed: PM17590143
2. Powers KA, Rehrig ST, Jones DB. Financial impact of obesity and bariatric surgery. Med
Clin North Am 2007;91(3):321-38, ix. PubMed: PM17509381
3. Kushner RF, Noble CA. Long-term outcome of bariatric surgery: an interim analysis. Mayo
Clin Proc 2006;81(10 Suppl):S46-S51. PubMed: PM17036578
4. Deitel M. Bariatric surgery is a cost-saving for the healthcare system. Obes Surg
2005;15(3):301-3. PubMed: PM15826460
Additional references
1. Jensen C, Flum DR. The costs of nonsurgical and surgical weight loss interventions: is an
ounce of prevention really worth a pound of cure? Surg Obes Relat Dis 2005;1(3):353-7.
PubMed: PM16925247
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