title: Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity.
abstract: OBJECTIVE
  One-third of Americans are obese and an increasing number opt for bariatric surgery. This study estimates the cost-effectiveness of common bariatric surgical procedures from a healthcare system perspective.
  
  
  METHODS
  We evaluated the three most common bariatric surgical procedures in the US: laparoscopic gastric bypass (LRYGB), conventional (open) Roux-en-Y gastric bypass (ORYGB), and laparoscopic adjustable gastric banding (LAGB) compared to no surgery. The reference case was defined as a 53-year old female with body mass index (BMI) of 44 kg/m(2). We developed a two-part model using a deterministic approach for the first 5-year period post-surgery and separate empirical forecasts for the natural history of BMI, costs and outcomes in the remaining years. We used a combination of datasets including Medicare and MarketScan(®) together with estimates from the literature to populate the model.
  
  
  RESULTS
  Bariatric surgery produced additional life expectancy (80-81 years) compared to no surgery (78 years). The incremental cost-effectiveness ratios (ICERs) of the surgical procedures were US $6,600 per quality-adjusted life expectancy (QALY) gained for LRYGB, US $6,200 for LAGB, and US $17,300 for ORYGB (3 % discount rate for cost and QALYs). ICERs varied according to choice of BMI forecasting method and clinically plausible variation in parameter estimates. In most scenarios, the ICER did not exceed a threshold of US $50,000 per QALY gained.
authors.affiliation: Pharmaceutical Outcomes Research and Policy Program, University of Washington, 1959 NE Pacific Ave, H375Q, Seattle, WA, 98195, USA.
authors.forename: Bruce C M
authors.initials: BC
authors.lastname: Wang
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.forename: Rafael
authors.initials: R
authors.lastname: Alfonso-Cristancho
authors.forename: Hao
authors.initials: H
authors.lastname: He
authors.forename: David R
authors.initials: DR
authors.lastname: Flum
authors.forename: David E
authors.initials: DE
authors.lastname: Arterburn
authors.forename: Louis P
authors.initials: LP
authors.lastname: Garrison
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D050110:Bariatric Surgery / Q000191:economics* / Q000379:methods*; D015992:Body Mass Index; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D018803:Models, Economic; D009767:Obesity, Morbid / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years