Bariatric surgery may be cost-effective for obesity with type 2 diabetes

A gastric band

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.

Clinical question

In severely obese people with type 2 diabetes, is bariatric surgery cost-effective compared with usual care?

The evidence

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).

Appraisal hints

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.


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I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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