An economic evaluation reported by the Centre for Reviews and Dissemination concludes that bariatric surgery, whether gastric bypass or gastric band, is cost-effective in a US payor setting.
In severely obese people with type 2 diabetes, is bariatric surgery cost-effective compared with usual care?
This is a critical appraisal of a review that was originally published in 2010.
Although it resulted in greater overall costs than usual care, bariatric surgery was considered cost-effective because it reduced weight and improved quality of life.
Compared with usual care, the incremental cost per QALY gained was $7,000 for bypass surgery, and $11,000 for banding surgery, in newly diagnosed patients. It was $12,000 for bypass surgery, and $13,000 for banding surgery, in patients with established diabetes.
The CRD reviewers found several methodological problems with the evaluation, however (see below).
Users of this research should consider:
- Does the perspective match your own?
- Were all of the relevant costs identified and included? Do they include indirect costs?
- The estimates of the benefits of bariatric surgery may not be reliable, because they did not derive from a randomised trial that directly compared the two alternative methods. Similarly, the methods for deriving estimates of quality of life were not clearly reported.
- Are these methodological problems so great that this evaluation can’t help you?
The full text of the critical appraisal of an economic evaluation is available from the CRD:
Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Centre for Reviews and Dissemination, 2012.
The full text of the original economic evaluation is available from Diabetes Care journal:
Hoerger T, Zhang P et al. Cost-Effectiveness of Bariatric Surgery for Severely Obese Adults With Diabetes. Diabetes Care September 2010 vol. 33 no. 9 1933-1939
See also all Diabetes Elf posts on Bariatric Surgery.