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Cost-effectiveness of Adolescent Bariatric Surgery.

Bairdain S, Samnaliev M - Cureus (2015)

Bottom Line: Incremental costs per QALY of surgery vs. no surgery from a health care system perspective were then estimated.  At one year follow-up, mean weight loss was 37.5 (std. = 13.5) kg and the corresponding BMI was 35.4 (reduction of 13.2, p<0.01).A unit change in BMI was associated with future medical care savings of $157/year (p<0.01) and with an increase in HRQL of 0.004 (p<0.01) and life expectancy.Future studies on a large scale are needed to show a continued improvement in QALYs and to evaluate earlier cost-effectiveness of the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Boston Children's Hospital.

ABSTRACT

Background:  The current estimates of the prevalence of adolescent morbid obesity and severe morbid obesity are about 21% and 6.6%, respectively. Obesity, if left untreated, may result in a variety of comorbid conditions and earlier mortality. Adolescent bariatric surgery is an effective, but expensive means to ameliorate these conditions and the risk of earlier mortality. We aimed to develop a model to evaluate the long-term cost-effectiveness of bariatric surgery.

Methods: All adolescents who participated in our bariatric surgery multidisciplinary program from January 2010 to December 2013 were included if they had at least 12 months follow-up after their surgery. Intervention costs included all operative as well as preoperative and 12-month postoperative care. We used the US Medical Expenditures Panel Survey (MEPS) to estimate the association between reductions in BMI after surgery with future savings from reduced medical care use and with increased health-related quality of life (HRQL). We linked BMI with life expectancy using data from the Centers for Disease Control and Prevention. A Markov cohort model was then used to project health care-related costs (2013 US$), and quality-adjusted life years (QALYs) over time starting at age 18. Incremental costs per QALY of surgery vs. no surgery from a health care system perspective were then estimated.

Results:  At one year follow-up, mean weight loss was 37.5 (std. = 13.5) kg and the corresponding BMI was 35.4 (reduction of 13.2, p<0.01). Mean total intervention costs/person were $25,854 (std. = 2,044). A unit change in BMI was associated with future medical care savings of $157/year (p<0.01) and with an increase in HRQL of 0.004 (p<0.01) and life expectancy. At a threshold of a 100,000/QALY, bariatric surgery was not cost-effective in the first three years, but became cost-effective after that ($80,065/QALY in year four and $36,570/QALY in year seven). 

Conclusion:  Our results suggest that bariatric surgery among adolescents may be cost-effective when evaluated over a long period of time. Future studies on a large scale are needed to show a continued improvement in QALYs and to evaluate earlier cost-effectiveness of the procedure.

No MeSH data available.


Related in: MedlinePlus

Willingness to pay thresholdsThe probability of surgery being cost effective at different willingness to pay (WTP) thresholds and time periods is shown in Figure 1.
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FIG1: Willingness to pay thresholdsThe probability of surgery being cost effective at different willingness to pay (WTP) thresholds and time periods is shown in Figure 1.

Mentions: Table 3 (below) presents the differences in overall health care costs, life expectancy, and QALYs based on the Markov model over the first seven years. (Longer projections did not change our conclusions.) Overall, bariatric surgery remained more expensive than no surgery in the first seven years, with increasing medical cost savings over time ($1,989 after the first year and increasing to $11,012 over seven years) which partially offset the intervention costs. Surgery was also associated with gains in life expectancy of around 0.006 years (2.2 days) over a year, and increasing to 0.158 years (57 days) over seven years, as well as with increased QALYs of about 0.06 and 0.457 after one and seven years, respectively. Based on a threshold of $100,000/QALY, bariatric surgery was not cost-effective in the first three years after surgery, but became cost-effective following that time interval. The probability of surgery being cost-effective at different WTP thresholds and time periods is shown in Figure 1 below. At $100k/QALY, this probability was about 75% over four years and greater afterwards. None of the patients suffered complications within the first year.


Cost-effectiveness of Adolescent Bariatric Surgery.

Bairdain S, Samnaliev M - Cureus (2015)

Willingness to pay thresholdsThe probability of surgery being cost effective at different willingness to pay (WTP) thresholds and time periods is shown in Figure 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494559&req=5

FIG1: Willingness to pay thresholdsThe probability of surgery being cost effective at different willingness to pay (WTP) thresholds and time periods is shown in Figure 1.
Mentions: Table 3 (below) presents the differences in overall health care costs, life expectancy, and QALYs based on the Markov model over the first seven years. (Longer projections did not change our conclusions.) Overall, bariatric surgery remained more expensive than no surgery in the first seven years, with increasing medical cost savings over time ($1,989 after the first year and increasing to $11,012 over seven years) which partially offset the intervention costs. Surgery was also associated with gains in life expectancy of around 0.006 years (2.2 days) over a year, and increasing to 0.158 years (57 days) over seven years, as well as with increased QALYs of about 0.06 and 0.457 after one and seven years, respectively. Based on a threshold of $100,000/QALY, bariatric surgery was not cost-effective in the first three years after surgery, but became cost-effective following that time interval. The probability of surgery being cost-effective at different WTP thresholds and time periods is shown in Figure 1 below. At $100k/QALY, this probability was about 75% over four years and greater afterwards. None of the patients suffered complications within the first year.

Bottom Line: Incremental costs per QALY of surgery vs. no surgery from a health care system perspective were then estimated.  At one year follow-up, mean weight loss was 37.5 (std. = 13.5) kg and the corresponding BMI was 35.4 (reduction of 13.2, p<0.01).A unit change in BMI was associated with future medical care savings of $157/year (p<0.01) and with an increase in HRQL of 0.004 (p<0.01) and life expectancy.Future studies on a large scale are needed to show a continued improvement in QALYs and to evaluate earlier cost-effectiveness of the procedure.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Boston Children's Hospital.

ABSTRACT

Background:  The current estimates of the prevalence of adolescent morbid obesity and severe morbid obesity are about 21% and 6.6%, respectively. Obesity, if left untreated, may result in a variety of comorbid conditions and earlier mortality. Adolescent bariatric surgery is an effective, but expensive means to ameliorate these conditions and the risk of earlier mortality. We aimed to develop a model to evaluate the long-term cost-effectiveness of bariatric surgery.

Methods: All adolescents who participated in our bariatric surgery multidisciplinary program from January 2010 to December 2013 were included if they had at least 12 months follow-up after their surgery. Intervention costs included all operative as well as preoperative and 12-month postoperative care. We used the US Medical Expenditures Panel Survey (MEPS) to estimate the association between reductions in BMI after surgery with future savings from reduced medical care use and with increased health-related quality of life (HRQL). We linked BMI with life expectancy using data from the Centers for Disease Control and Prevention. A Markov cohort model was then used to project health care-related costs (2013 US$), and quality-adjusted life years (QALYs) over time starting at age 18. Incremental costs per QALY of surgery vs. no surgery from a health care system perspective were then estimated.

Results:  At one year follow-up, mean weight loss was 37.5 (std. = 13.5) kg and the corresponding BMI was 35.4 (reduction of 13.2, p<0.01). Mean total intervention costs/person were $25,854 (std. = 2,044). A unit change in BMI was associated with future medical care savings of $157/year (p<0.01) and with an increase in HRQL of 0.004 (p<0.01) and life expectancy. At a threshold of a 100,000/QALY, bariatric surgery was not cost-effective in the first three years, but became cost-effective after that ($80,065/QALY in year four and $36,570/QALY in year seven). 

Conclusion:  Our results suggest that bariatric surgery among adolescents may be cost-effective when evaluated over a long period of time. Future studies on a large scale are needed to show a continued improvement in QALYs and to evaluate earlier cost-effectiveness of the procedure.

No MeSH data available.


Related in: MedlinePlus