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BMC Surgery
Published in: BMC Surgery 1/2017

Open Access 01-12-2017 | Research article

Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling

Authors: Oleg Borisenko, Oliver Mann, Anna Duprée

Published in: BMC Surgery | Issue 1/2017

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Abstract

Background

The objective was to evaluate cost-utility of bariatric surgery in Germany for a lifetime and 10-year horizon from a health care payer perspective.

Methods

State-transition Markov model provided absolute and incremental clinical and monetary results. In the model, obese patients could undergo surgery, develop post-surgery complications, experience diabetes type II, cardiovascular diseases or die. German Quality Assurance in Bariatric Surgery Registry and literature sources provided data on clinical effectiveness and safety. The model considered three types of surgeries: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. The model was extensively validated, and deterministic and probabilistic sensitivity analyses were performed to evaluate uncertainty. Cost data were obtained from German sources and presented in 2012 euros (€).

Results

Over 10 years, bariatric surgery led to the incremental cost of €2909, generated additional 0.03 years of life and 1.2 quality-adjusted life years (QALYs). Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of €2457 per QALY. Over a lifetime, surgery led to savings of €8522 and generated an increment of 0.7 years of life or 3.2 QALYs. The analysis also depicted an association between surgery and a reduction of obesity-related adverse events (diabetes, cardiovascular disorders). Delaying surgery for up to 3 years, resulted in a reduction of life years and QALYs gained, in addition to a moderate reduction in associated healthcare costs.

Conclusions

Bariatric surgery is cost-effective at 10 years post-surgery and may result in a substantial reduction in the financial burden on the healthcare system over the lifetime of the treated individuals. It is also observed that delays in the provision of surgery may lead to a significant loss of clinical benefits.
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Metadata
Title
Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: a decision analytic modeling
Authors
Oleg Borisenko
Oliver Mann
Anna Duprée
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2017
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-017-0284-0

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