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. 2021 Oct;45(10):2179-2190.
doi: 10.1038/s41366-021-00849-8. Epub 2021 Jun 4.

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

D Boyers  1 , L Retat  2 , E Jacobsen  3 , A Avenell  4 , P Aveyard  5   6   7 , E Corbould  2 , A Jaccard  2 , D Cooper  4 , C Robertson  4 , M Aceves-Martins  4 , B Xu  2 , Z Skea  4 , M de Bruin  8   9 ; and the REBALANCE team
Collaborators, Affiliations

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

D Boyers et al. Int J Obes (Lond). 2021 Oct.

Erratum in

Abstract

Objectives: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.

Methods: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.

Results: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.

Conclusions: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

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Conflict of interest statement

PA was an investigator on an investigator-initiated trial funded by Cambridge Weight Plan, and has done half a day’s consultancy for Weight Watchers. These activities led to payments to the University of Oxford for his time but no payments to him personally. All others: none declared.

Figures

Fig. 1
Fig. 1. BMI change over time (base-case analysis).
details the modelled BMI change over time. The main figure panel includes all modelled interventions, including surgery. The embedded panel details the BMI change modelled for non-surgical WMPs only. Abbreviations: BMI = Body Mass Index; WMP = Weight Management Programme; VLCD = Very low calorie diet; RYGB = Roux-en-Y gastric bypass surgery.
Fig. 2
Fig. 2. Cumulative incidence cases of obesity related disease avoided per 100,000 population with BMI ≥ 35 KG/M2 compared to population trends.
details the cumulative incidence of 12 obesity related disease avoided per 100,000 population with a BMI of 35 and above for each modelled intervention compared to standard care. Abbreviations: BMI = Body Mass Index; WMP = Weight Management Programme; VLCD = Very low calorie diet; RYGB = Roux-en-Y gastric bypass surgery.
See this image and copyright information in PMC

References

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