Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity.
OBJECTIVE
To assess the cost-effectiveness of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) as treatment for morbid obesity.


METHODS
A Markov model was developed to simulate weight loss, health consequences, and costs for surgical treatment of morbid obesity. The model was used to estimate incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained.


METHODS
Estimates of procedure effectiveness were derived from published results of a head-to-head randomized controlled trial. Other model parameters, including complication rates, costs of treatment, adverse events and obesity, mortality rates, and utilities, were estimated from published literature and publicly available databases. Costs (2006 US dollars) and QALYs were discounted by 3% per annum.


RESULTS
Under conservative assumptions, both LAGB and LRYGB improved health outcomes, at a higher cost, compared with no treatment. ICERs for both LAGB and LRYGB versus no treatment were below $25,000 per QALY gained. ICERs were lower for individuals with higher initial body mass index and higher for older individuals. ICERs for men were generally higher than those of women. Sensitivity analyses showed these results to be robust to reasonable variation in model parameters and overall parameter uncertainty. Base-case ICERs for LRYGB versus LAGB were below $25,000 per QALY gained, but were highly sensitive to model assumptions.


CONCLUSIONS
Both LAGB and LRYGB provide significant weight loss and are cost-effective compared with no treatment at conventionally accepted thresholds for medical interventions.
Campbell
Joanna
J
i3 Innovus, Medford, MA, USA. joanna.campbell@i3innovus.com
McGarry
Lisa A
LA
Shikora
Scott A
SA
Hale
Brent C
BC
Lee
Jeffrey T
JT
Weinstein
Milton C
MC
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D015390:Gastric Bypass / Q000191:economics*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D055815:Young Adult