Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis

ABSTRACT

Background: We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain.

Methods: We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (€2017).

Results: Over the 10-year horizon, BS led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and €300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss.

Conclusions: Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.

KEYWORDS:

• Bariatric surgery
• obesity
• cost-effectiveness
• economic evaluation
• Markov
• Spain

Acknowledgments

To the Instituto de Investigación Biomédica Galicia Sur.

Declaration of Interest

O Borisenko and D Adam were full-time employees of Synergus AB at the time this study was developed. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. A reviewer on this manuscript has disclosed affiliation with Intuitive Surgical Inc., Ethicon Endosurgery Inc. Editing assistance was provided by San Francisco Edit and funded by Covidien AG.

Author Contribution Statement

RS-S, DA and OB researched literature and conceived the study. DA and OB designed, implemented and ran the simulation model to which RS-S, EMP, SEF, ECD, SGF, JTV, JCRA and FdCV gathered and supplied additional data, validated the design and reviewed the results. DA and OB performed the analysis and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Additional information

Funding

This work was supported by Covidien AG (now a Medtronic company).