title: Weight loss surgery for mild to moderate obesity: a systematic review and economic evaluation.
abstract: BACKGROUND
  A systematic review and economic evaluation was commissioned to determine the effectiveness and cost-effectiveness of bariatric surgery for mild [class I, body mass index (BMI) 30 to 34.99] or moderate (class II, BMI 35 to 39.99) obesity.
  
  
  METHODS
  We searched 17 electronic resources (to February 2010) and other sources. Studies meeting predefined criteria were identified, data-extracted and assessed for risk of bias using standard methodology. A model was developed to estimate cost-effectiveness.
  
  
  RESULTS
  Two RCTs were included. Evidence from both indicated a statistically significant benefit from laparoscopic adjustable banding (LAGB) compared to a non-surgical comparator for weight loss and in obesity-related comorbidity. Both interventions were associated with adverse events. LAGB costs more than non-surgical management. For people with class I or II obesity and type 2 diabetes (T2D), the incremental cost-effectiveness ratio (ICER) at 2 years is £20,159, reducing to £4,969 at 5 years and £1,634 at 20 years. Resolution of T2D makes the greatest contribution to this reduction. In people with class I obesity, the ICER is £63,156 at 2 years, £17,158 at 5 years, and £13,701 at 20 years. Cost-effectiveness results are particularly sensitive to utility gain from reduction in BMI, factors associated with poorer surgical performance and diabetes health state costs.
  
  
  CONCLUSIONS
  Bariatric surgery appears to be a clinically effective and cost-effective intervention for people with class I or II obesity who also have T2D but is less likely to be cost-effective for people with class I obesity.
authors.affiliation: Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Epsilon House, Enterprise Road, Southampton Science Park, Southampton, UK, SO16 7NS. j.picot@soton.ac.uk
authors.forename: Joanna
authors.initials: J
authors.lastname: Picot
authors.forename: Jeremy
authors.initials: J
authors.lastname: Jones
authors.forename: Jill L
authors.initials: JL
authors.lastname: Colquitt
authors.forename: Emma
authors.initials: E
authors.lastname: Loveman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Clegg
mesh_terms: D050110:Bariatric Surgery / Q000191:economics*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D018803:Models, Economic; D009765:Obesity / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012720:Severity of Illness Index; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D015431:Weight Loss