RT Journal Article
SR Electronic
T1 The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost–utility analysis
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E673
OP E679
DO 10.9778/cmajo.20200188
VO 9
IS 2
A1 Lester, Erica L.W.
A1 Padwal, Raj S.
A1 Birch, Daniel W.
A1 Sharma, Arya M.
A1 So, Helen
A1 Ye, Feng
A1 Klarenbach, Scott W.
YR 2021
UL http://www.cmajopen.ca/content/9/2/E673.abstract
AB Background: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost–utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives.Methods: We conducted a cost–utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m2 and a major medical comorbidity or BMI ≥ 40 kg/m2) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses.Results: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost–effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis.Interpretation: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.