Surgery for Obesity and Related Diseases
Volume 4, Issue 1 , Pages 26-32 , January 2008

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

  • Leon Salem, M.D.

      Affiliations

    • Department of Surgery, University of Washington School of Medicine, Seattle, Washington
  • ,
  • Allison Devlin, M.S.

      Affiliations

    • Department of Surgery, University of Washington School of Medicine, Seattle, Washington
  • ,
  • Sean D. Sullivan, Ph.D.

      Affiliations

    • Department of Pharmacy, University of Washington School of Medicine, Seattle, Washington
    • Department of Health Services, University of Washington School of Medicine, Seattle, Washington
  • ,
  • David R. Flum, M.D., M.P.H., F.A.C.S.

      Affiliations

    • Department of Surgery, University of Washington School of Medicine, Seattle, Washington
    • Department of Health Services, University of Washington School of Medicine, Seattle, Washington
    • Corresponding Author InformationReprint 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.

Received 10 May 2007 ,Revised 9 August 2007 ,Accepted 9 September 2007.

References 

  1. Mokdad A, Serdula M, Dietz W, Bowman B, Marks J, Koplan J. The continuing epidemic of obesity in the United States. JAMA. 2000;284:1650–1651
  2. Finkelstein EA, Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much, and who’s paying?. Health Aff (Millwood). 2003;219–226Jan–Jun(Suppl W3)
  3. McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139:933–949
  4. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–1737
  5. Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–498
  6. Thompson D, Edelsberg J, Colditz G, Bird A, Oster G. Lifetime health and economic consequences of obesity. Arch Intern Med. 1999;159:2177–2183
  7. Suter M, Bettschart V, Giusti V, Heraief E, Jayet A. A 3-year experience with laparoscopic gastric banding for obesity. Surg Endosc. 2000;14:532–536
  8. O’Brien PE, Brown WA, Smith A, McMurrick PJ, Stephens M. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg. 1999;86:113–118
  9. Kellum J, DeMaria E, Sugerman H. The surgical treatment of morbid obesity. Curr Probl Surg. 1998;35:791–858
  10. De Luca M, de Werra E, Formato A, et al. Laparotomic vs laparoscopic lap-band: 4-year results with early and intermediate complications. Obes Surg. 2000;10:266–268
  11. Dargent J. Laparoscopic adjustable gastric banding: lessons from the first 500 patients in a single institution. Obes Surg. 1999;9:446–452
  12. Freeman JB, Kotlarewsky M, Phoenix C. Weight loss after extended gastric bypass. Obes Surg. 1997;7:337–344
  13. Smith SC, Goodman GN, Edwards CB. Roux-en-Y gastric bypass: a 7-year retrospective review of 3,855 patients. Obes Surg. 1995;5:314–318
  14. Fobi MA, Lee H, Igwe D, Stanczyk M, Tambi JN. Prospective comparative evaluation of stapled versus transected silastic ring gastric bypass: 6-year follow-up. Obes Surg. 2001;11:18–24
  15. Howard L, Malone M, Michalek A, Carter J, Alger S, Van Woert J. Gastric bypass and vertical banded gastroplasty—a prospective randomized comparison and 5-year follow-up. Obes Surg. 1995;5:55–60
  16. Capella JF, Capella RF. The weight reduction operation of choice: vertical banded gastroplasty or gastric bypass?. Am J Surg. 1996;171:74–79
  17. Balsiger BM, Kennedy FP, Abu-Lebdeh HS, et al. Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clin Proc. 2000;75:673–680
  18. MacLean L, Rhode B, Forse R, Nohr R. Surgery for obesity—an update of a randomized trial. Obes Surg. 1995;5:145–150
  19. Fox SR, Oh KH, Fox K. Vertical banded gastroplasty and distal gastric bypass as primary procedures: a comparison. Obes Surg. 1996;6:421–425
  20. Schauer P, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232:515–529
  21. Kalfarentzos F, Dimakopoulos A, Kehagias I, Loukidi A, Mead N. Vertical banded gastroplasty versus standard or distal Roux-en-Y gastric bypass based on specific selection criteria in the morbidly obese: preliminary results. Obes Surg. 1999;9:433–442
  22. Sugerman H, Starkey J, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205:613–624
  23. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135:326–351
  24. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;1994:543–551
  25. Jones KB. Experience with the Roux-en-Y gastric bypass, and commentary on current trends. Obes Surg. 2000;10:183–185
  26. Higa K, Boone K, Ho T, Davies O. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135:1029–1033
  27. Toppino M, Morino M, Bonnet G, Nigra I, Siliquini R. Laparoscopic surgery for morbid obesity: preliminary results from SICE registry (Italian Society of Endoscopic and Minimally Invasive Surgery). Obes Surg. 1999;9:62–65
  28. Angrisani L, Alkilani M, Basso N, et al. Laparoscopic Italian experience with the Lap-Band. Obes Surg. 2001;11:307–310
  29. Drug Topics Red Book. Montvale, NJ: Medical Economics Company; 2003;
  30. Gallager S, Banasiak M, Gonzalvo J, et al. The impact of bariatric surgery on the Veterans Administration healthcare system: a cost analysis. Obes Surg. 2003;13:245–248
  31. Flum D, Salem L, Broeckel Elrod J, Dellinger E, Cheadle A, Chan L. Early mortality among Medicare beneficiaries undergoing bariatric surgical procedures. JAMA. 2005;294:1903–1908
  32. Jan J, Hong D, Pereira N, Patterson E. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results. J Gastrointest Surg. 2005;9:30–39
  33. Clegg AJ, Colquitt J, Sidhu MK, Royle P, Loveman E, Walker A. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. Health Technol Assess. 2002;6:1–153
  34. O’Brien P, McPhail T, Chaston T, Dixon J. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–1040
  35. Pories W, Swanson M, MacDonald K. Who would have thought it? (An operation proves to be the most effective therapy for adult-onset diabetes mellitus). Ann Surg. 1995;222:339–350
  36. Pope G, Finlayson S, Kemp J, Birkmeyer J. Life expectancy benefits of gastric bypass. Surg Innovat. 2006;13:265–273
  37. Jan J, Hong D, Bardaro S, July L, Patterson E. Comparative study between laparoscopic adjustable gastric banding and laparoscopic gastric bypass: single-institution, 5-year experience in bariatric surgery. Surg Obes Relat Dis. 2007;3:42–51
  38. Dixon J. Survival advantage with bariatric surgery: report from the 10th International Congress on Obesity. Surg Obes Relat Dis. 2006;2:585–586
  39. Jensen C, Flum D. The costs of nonsurgical and surgical weight loss interventions: is an ounce of prevention really worth a pound of cure?. Surg Obes Relat Dis. 2005;1:353–357
  40. Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187–193
  41. Nguyen N, Goldman C, Rosenquist C, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg. 2001;234:279–289

 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.

PII: S1550-7289(07)00672-7

doi: 10.1016/j.soard.2007.09.009

Surgery for Obesity and Related Diseases
Volume 4, Issue 1 , Pages 26-32 , January 2008