Skip to main navigation menu Skip to main content Skip to site footer

Systematic review

Vol. 148 No. 2324 (2018)

Adaptation of cost-effectiveness analyses to a single country: the case of bariatric surgery for obesity and overweight

DOI
https://doi.org/10.4414/smw.2018.14626
Cite this as:
Swiss Med Wkly. 2018;148:w14626
Published
12.06.2018

Abstract

OBJECTIVES

The aims of this study were to (a) identify and assess the quality of reporting of published cost-effectiveness studies of bariatric surgery, (b) assess their transferability to Switzerland, and (c) adapt transferable cost-effectiveness results to Switzerland.

METHODS

A systematic literature search was performed in Medline, Embase and other databases. Two reviewers independently undertook screening, extraction, assessment of reporting quality utilising the Consolidated Health Economic Evaluation Reporting Standards, transferability, adaptation of cost data and recalculation of cost-effectiveness results. Cost data were adapted in three steps: correction for different levels of resource utilisation, for different prices of healthcare services and for change in costs over time.

RESULTS

Fifteen studies fulfilled criteria for adaptation of cost data to Switzerland. Four out of fifteen adapted studies with a long time-horizon for patients with a body mass index (BMI) >35kg/m2 indicated bariatric surgery to be a cost-saving (dominant) approach compared with conventional treatment. Other studies for patients with BMI >35kg/m2 showed cost-effective results, with incremental cost-effectiveness ratios (ICERs) below CHF 50,000 per quality adjusted life-year (QALY) gained. Two studies assessed cost-effectiveness for patients with BMI <35kg/m2, and revealed ICERs below 50,000 per QALY gained for bariatric surgery versus conventional treatment. Between-study differences were related to approaches for the modelling effectiveness and costs, time horizon, population, type of intervention and possibly other unidentified reasons. Gastric bypass appeared to be superior to gastric banding, but was more expensive.

CONCLUSIONS

Nearly all studies found bariatric surgery to be a cost saving or cost-effective compared with conventional treatment. The adaptation of existing cost-effectiveness analyses cannot be considered to give accurate ICERs for Switzerland, but may have achieved an approximation of cost-effectiveness levels to be expected for Switzerland. It has made the results of international cost-effectiveness studies reported for different countries and in different currencies more comparable, and may be useful for individual countries in which financing or capacity for economic analyses is scarce.

References

  1. Dixon JB. The effect of obesity on health outcomes. Mol Cell Endocrinol. 2010;316(2):104–8. doi:.https://doi.org/10.1016/j.mce.2009.07.008
  2. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9945):766–81. doi:.https://doi.org/10.1016/S0140-6736(14)60460-8
  3. Picot J, Jones J, Colquitt JL, Gospodarevskaya E, Loveman E, Baxter L, et al. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation. Health Technol Assess. 2009;13(41):1–190, 215–357, iii–iv. doi:.https://doi.org/10.3310/hta13410
  4. Hammond RA, Levine R. The economic impact of obesity in the United States. Diabetes Metab Syndr Obes. 2010;3:285–95. doi:.https://doi.org/10.2147/DMSO.S7384
  5. Finkelstein EA, Strombotne KL. The economics of obesity. Am J Clin Nutr. 2010;91(5):1520S–4S. doi:.https://doi.org/10.3945/ajcn.2010.28701E
  6. Schneider H, Venetz W. Cost of Obesity in Switzerland in 2012. Report prepared on behalf of the Bundesamt fur Gesundheit, Contact-Number 13.005445. Available at: https://www.bag.admin.ch/dam/bag/fr/dokumente/npp/forschungsberichte/forschungsberichte-e-und-b/cost-of-obesity.pdf.download.pdf/cost-of-obesity.pdf.
  7. Swiss Society for the Study of Morbid Obesity and Metabolic Disorders (SMOB). Richtlinien zur operativen Behandlung von Übergewicht (Medizinische Richtlinien). In: Medizinische Richtlinien zur operativen Behandlung von Übergewicht. 2013.
  8. Bundesamt für Gesundheit (BAG). Verordnung des EDI über Leistungen in der obligatorischen Krankenpflegeversicherung, Stand 15. September 2015. Available at: https://www.admin.ch/opc/de/classified-compilation/19950275/201803010000/832.112.31.pdf.
  9. Royle P, Waugh N. Literature searching for clinical and cost-effectiveness studies used in health technology assessment reports carried out for the National Institute for Clinical Excellence appraisal system. Health Technol Assess. 2003;7(34):iii, ix–x, 1–51. doi:.https://doi.org/10.3310/hta7340
  10. Clegg A, Colquitt J, Sidhu M, Royle P, Walker A. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes Relat Metab Disord. 2003;27(10):1167–77. doi:.https://doi.org/10.1038/sj.ijo.0802394
  11. 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(12):1–153. doi:.https://doi.org/10.3310/hta6120
  12. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339(jul21 1):b2700. doi:.https://doi.org/10.1136/bmj.b2700
  13. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al.; ISPOR Health Economic Evaluation Publication Guidelines-CHEERS Good Reporting Practices Task Force. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)--explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231–50. doi:.https://doi.org/10.1016/j.jval.2013.02.002
  14. Welte R, Feenstra T, Jager H, Leidl R. A decision chart for assessing and improving the transferability of economic evaluation results between countries. Pharmacoeconomics. 2004;22(13):857–76. doi:.https://doi.org/10.2165/00019053-200422130-00004
  15. Drummond M, Barbieri M, Cook J, Glick HA, Lis J, Malik F, et al. Transferability of economic evaluations across jurisdictions: ISPOR Good Research Practices Task Force report. Value Health. 2009;12(4):409–18. doi:.https://doi.org/10.1111/j.1524-4733.2008.00489.x
  16. O’Brien BJ. A tale of two (or more) cities: geographic transferability of pharmacoeconomic data. Am J Manag Care. 1997;3(Suppl):S33–9.
  17. Wieser S, Tomonaga Y, Riguzzi M, et al. Die Kosten der nichtübertragbaren Krankheiten in der Schweiz. https://www.bag.admin.ch/dam/bag/de/dokumente/npp/forschungsberichte/forschungsberichte-ncd/kosten-ncd-in-der-schweiz.pdf.download.pdf/Schlussbericht%20COI%20NCDs%20in%20CH%202014%2007%2021.pdf. 2014.
  18. Brändle M, Goodall G, Erny-Albrecht KM, Erdmann E, Valentine WJ. Cost-effectiveness of pioglitazone in patients with type 2 diabetes and a history of macrovascular disease in a Swiss setting. Swiss Med Wkly. 2009;139(11-12):173–84. doi:https://smw.ch/en/article/doi/smw.2009.12381/.
  19. OECD. Health Statistics 2015 - Frequently Requested Data - Total health expenditure per capita, US$ PPP. Secondary Health Statistics 2015 - Frequently Requested Data - Total health expenditure per capita, US$ PPP. http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm.
  20. OECD. Health Statistics 2015 - Purchasing Power Parities for GDP and related indicators. Secondary Health Statistics 2015 - Purchasing Power Parities for GDP and related indicators. http://stats.oecd.org/.
  21. Office SFS. Kosten der Gesundheitswesen seit 1960. Secondary Kosten der Gesundheitswesen seit 1960 2015 http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/01/new/nip_detail.html?gnpID=2014-095.
  22. Craig BM, Tseng DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113(6):491–8. doi:.https://doi.org/10.1016/S0002-9343(02)01266-4
  23. Health Statistics OECD. 2015 - Frequently Requested Data - Total health expenditure per capita, US$ PPP. In.
  24. Health Statistics OECD. 2015 - Purchasing Power Parities for GDP and related indicators. In.
  25. Office SFS. Kosten der Gesundheitswesen seit 1960. Secondary Kosten der Gesundheitswesen seit 1960 2015 http://www.bfs.admin.ch/bfs/portal/de/index/themen/14/01/new/nip_detail.html?gnpID=2014-095.
  26. Ackroyd R, Mouiel J, Chevallier JM, Daoud F. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503. doi:.https://doi.org/10.1381/096089206778870067
  27. Borg S, Näslund I, Persson U, Ödegaard K. Obesity and Surgical Treatment – A Cost-Effectiveness Assessment for Sweden. Nordic Journal of Health Economics. 2014;2(1):257–75. doi:.https://doi.org/10.5617/njhe.207
  28. Campbell J, McGarry LA, Shikora SA, Hale BC, Lee JT, Weinstein MC. Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity. Am J Manag Care. 2010;16(7):e174–87.
  29. Castilla I, Mar J, Valcárcel-Nazco C, Arrospide A, Ramos-Goñi JM. Cost-utility analysis of gastric bypass for severely obese patients in Spain. Obes Surg. 2014;24(12):2061–8. doi:.https://doi.org/10.1007/s11695-014-1304-0
  30. Hoerger TJ, Zhang P, Segel JE, Kahn HS, Barker LE, Couper S. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes. Diabetes Care. 2010;33(9):1933–9. doi:.https://doi.org/10.2337/dc10-0554
  31. Ikramuddin S, Klingman D, Swan T, Minshall ME. Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients. Am J Manag Care. 2009;15(9):607–15.
  32. Keating CL, Dixon JB, Moodie ML, Peeters A, Playfair J, O’Brien PE. Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2009;32(4):580–4. doi:.https://doi.org/10.2337/dc08-1748
  33. Michaud PC, Goldman DP, Lakdawalla DN, Zheng Y, Gailey AH. The value of medical and pharmaceutical interventions for reducing obesity. J Health Econ. 2012;31(4):630–43. doi:.https://doi.org/10.1016/j.jhealeco.2012.04.006
  34. Picot J, Jones J, Colquitt JL, Loveman E, Clegg AJ. Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation. Obes Surg. 2012;22(9):1496–506. doi:.https://doi.org/10.1007/s11695-012-0679-z
  35. Pollock RF, Muduma G, Valentine WJ. Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK. Diabetes Obes Metab. 2013;15(2):121–9. doi:.https://doi.org/10.1111/j.1463-1326.2012.01692.x
  36. Wang BC, Wong ES, Alfonso-Cristancho R, He H, Flum DR, Arterburn DE, et al. Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity. Eur J Health Econ. 2014;15(3):253–63. doi:.https://doi.org/10.1007/s10198-013-0472-5
  37. Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34. doi:.https://doi.org/10.1111/joim.12012
  38. Ananthapavan J, Moodie M, Haby M, Carter R. Assessing cost-effectiveness in obesity: laparoscopic adjustable gastric banding for severely obese adolescents. Surg Obes Relat Dis. 2010;6(4):377–85. doi:.https://doi.org/10.1016/j.soard.2010.02.040
  39. Anselmino M, Bammer T, Fernández Cebrián JM, Daoud F, Romagnoli G, Torres A. Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II). Obes Surg. 2009;19(11):1542–9. doi:.https://doi.org/10.1007/s11695-009-9946-z
  40. Faria GR, Preto JR, Costa-Maia J. Gastric bypass is a cost-saving procedure: results from a comprehensive Markov model. Obes Surg. 2013;23(4):460–6. doi:.https://doi.org/10.1007/s11695-012-0816-8
  41. Jensen C, Flum DR ; 2004 ABS Consensus Conference. 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(3):353–7. doi:.https://doi.org/10.1016/j.soard.2005.03.215
  42. McEwen LN, Coelho RB, Baumann LM, Bilik D, Nota-Kirby B, Herman WH. The cost, quality of life impact, and cost-utility of bariatric surgery in a managed care population. Obes Surg. 2010;20(7):919–28. doi:.https://doi.org/10.1007/s11695-010-0169-0
  43. Salem L, Devlin A, Sullivan SD, Flum DR. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg Obes Relat Dis. 2008;4(1):26–32. doi:.https://doi.org/10.1016/j.soard.2007.09.009
  44. Mäklin S, Malmivaara A, Linna M, Victorzon M, Koivukangas V, Sintonen H. Cost-utility of bariatric surgery for morbid obesity in Finland. Br J Surg. 2011;98(10):1422–9. doi:.https://doi.org/10.1002/bjs.7640
  45. Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differentiated long-term effects of intentional weight loss on diabetes and hypertension. Hypertension. 2000;36(1):20–5. doi:.https://doi.org/10.1161/01.HYP.36.1.20
  46. Sjöström L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al.; Swedish Obese Subjects Study Scientific Group. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. doi:.https://doi.org/10.1056/NEJMoa035622
  47. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, et al.; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52. doi:.https://doi.org/10.1056/NEJMoa066254
  48. Angrisani L, Lorenzo M, Borrelli V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):127–32, discussion 132–3. doi:.https://doi.org/10.1016/j.soard.2006.12.005
  49. O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40. doi:.https://doi.org/10.1381/096089206778026316
  50. Padwal R, Klarenbach S, Wiebe N, Hazel M, Birch D, Karmali S, et al. Bariatric surgery: a systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26(10):1183–94. doi:.https://doi.org/10.1007/s11606-011-1721-x
  51. Vilarrasa N, de Gordejuela AG, Gómez-Vaquero C, Pujol J, Elio I, San José P, et al. Effect of bariatric surgery on bone mineral density: comparison of gastric bypass and sleeve gastrectomy. Obes Surg. 2013;23(12):2086–91. doi:.https://doi.org/10.1007/s11695-013-1016-x
  52. Carrasco F, Basfi-Fer K, Rojas P, Valencia A, Csendes A, Codoceo J, et al. Changes in bone mineral density after sleeve gastrectomy or gastric bypass: relationships with variations in vitamin D, ghrelin, and adiponectin levels. Obes Surg. 2014;24(6):877–84. doi:.https://doi.org/10.1007/s11695-014-1179-0

Most read articles by the same author(s)

1 2 > >>