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AIM: To determine the cost-effectiveness of gastric band surgery in overweight but not obese people who receive standard diabetes care. METHOD: A microsimulation model (United Kingdom Prospective Diabetes Study outcomes model) was used to project diabetes outcomes and costs from a two-year Australian randomized trial of gastric band (GB) surgery in overweight but not obese people (BMI 25 to 30kg/m2) on to a comparable population of U.S. adults from the National Health and Nutrition Examination Survey (N=254). Estimates of cost-effectiveness were calculated based on the incremental cost-effectiveness ratios (ICERs) for different treatment scenarios. Costs were inflated to 2015 U.S. dollar values and an ICER of less than $50,000 per QALY gained was considered cost-effective. RESULTS: The incremental cost-effectiveness ratio for GB surgery at two years exceeded $90,000 per quality-adjusted life year gained but decreased to $52,000, $29,000 and $22,000 when the health benefits of surgery were assumed to endure for 5, 10 and 15 years respectively. The cost-effectiveness of GB surgery was sensitive to utility gained from weight loss and, to a lesser degree, the costs of GB surgery. However, the cost-effectiveness of GB surgery was affected minimally by improvements in HbA1c, systolic blood pressure and cholesterol. CONCLUSIONS: GB surgery for overweight but not obese people with T2D appears to be cost-effective in the U.S. setting if weight loss endures for more than five years. Health utility gained from weight loss is a critical input to cost-effectiveness estimates and therefore should be routinely measured in populations undergoing bariatric surgery.

Original publication

DOI

10.1016/j.jdiacomp.2017.04.009

Type

Journal

J Diabetes Complications

Publication Date

07/2017

Volume

31

Pages

1139 - 1144

Keywords

Bariatric surgery, Cost-effectiveness, Gastric band surgery, Overweight but not obese, Type 2 diabetes, Australia, Bariatric Surgery, Body Mass Index, Combined Modality Therapy, Cost of Illness, Cost-Benefit Analysis, Costs and Cost Analysis, Diabetes Mellitus, Type 2, Health Care Costs, Humans, Middle Aged, Models, Economic, Nutrition Surveys, Overweight, Quality of Life, Randomized Controlled Trials as Topic, United States, Weight Loss