Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions
Presented at the 91st Annual Clinical Congress of the American College of Surgeons, San Francisco, California, October 16–20, 2005
Received 10 May 2007; received in revised form 9 August 2007; accepted 9 September 2007. published online 10 December 2007.
Abstract
Background
Laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures. Although both procedures likely reduce healthcare expenditures related to the resolution of co-morbid conditions, they have different rates of perioperative risks and different rates of associated weight loss. We designed a model to evaluate the incremental cost-effectiveness of these procedures compared with nonoperative weight loss interventions and with each other.
Methods
We used a deterministic, payer-perspective model comparing the lifetime expected costs and outcomes of LAGB, LRYGB, and nonoperative treatment. The major endpoints were survival, health-related quality of life, and weight loss. Life expectancy and lifetime medical costs were calculated across age, gender, and body mass index (BMI) strata using previously published data.
Results
For both men and women, LRYGB and LAGB were cost-effective at <$25,000/quality-adjusted life-year (QALY) even when evaluating the full range of baseline BMI and estimates of adverse outcomes, weight loss, and costs. For base-case scenarios in men (age 35 y, BMI 40 kg/m2), the incremental cost-effectiveness was $11,604/QALY for LAGB compared with $18,543/QALY for LRYGB. For base-case scenarios in women (age 35 y, BMI 40 kg/m2), the incremental cost-effectiveness was $8878/QALY for LAGB compared with $14,680/QALY for LRYGB.
Conclusion
The modeled cost-effectiveness analysis showed that both operative interventions for morbid obesity, LAGB and RYGB, were cost-effective at <$25,000 and that LAGB was more cost-effective than RYGB for all base-case scenarios.
aDepartment of Surgery, University of Washington School of Medicine, Seattle, Washington
bDepartment of Pharmacy, University of Washington School of Medicine, Seattle, Washington
cDepartment of Health Services, University of Washington School of Medicine, Seattle, Washington
Reprint requests: David R. Flum, M.D., M.P.H., Department of Surgery, University of Washington School of Medicine, BB 431, 1959 Northeast Pacific Street, Box 356410, Seattle, WA 98195-6410.
Supported in part by an undirected educational gift from Inamed Corporation, Santa Barbara, California, and a National Institutes of Health grant 1-R21-DK069677-01 to L. Salem.
ABSTRACT