title: Clinical Indications, Utilization, and Funding of Bariatric Surgery in Europe.
abstract: OBJECTIVE
  The objective of this study was to evaluate the current utilization, the level of endorsement by professional societies, and health technology assessment bodies, as well as the reimbursement levels for bariatric surgery in European countries.
  
  
  METHODS
  We performed an analysis of the indications for bariatric surgery based on national clinical and commissioning guidelines, current utilization of surgery, characteristics of patients who underwent surgery, and reimbursement tariffs in Belgium, Denmark, England, France, Germany, Italy, and Sweden. Data were obtained from national patient registries, administrative databases, and published literature for the year 2012.
  
  
  RESULTS
  Despite clear consensus outlined in clinical guidelines, significant differences were found in the eligibility criteria for surgery. Patients with no significant comorbidities were deemed eligible if they had a body mass index (BMI) of 40 or 50 kg/m(2) in Denmark. Irrespective of the country, patients with comorbidities were eligible if they had a BMI of 35 kg/m(2). The highest utilization of bariatric surgery (number of surgeries per 1 M population) was observed in Belgium (928), Sweden (761), and France (571) while Italy (128), England (117), and Germany (72) had the lowest utilization. There was a strong negative correlation between utilization and average BMI level of the patient population (r = -.909, p = 0.005). The annual per capita spending on surgery differed significantly between countries, ranging from <euro>0.54 in Germany to <euro>4.33 in Belgium.
  
  
  CONCLUSIONS
  There are significant variations in the clinical indications, utilization, and funding of bariatric surgery in European countries.
authors.affiliation: Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden, oleg.borisenko@synergus.com.
authors.forename: Oleg
authors.initials: O
authors.lastname: Borisenko
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Colpan
authors.forename: Bruno
authors.initials: B
authors.lastname: Dillemans
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
authors.forename: Jan
authors.initials: J
authors.lastname: Hedenbro
authors.forename: Ahmed R
authors.initials: AR
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000191:economics / Q000706:statistics & numerical data; D015992:Body Mass Index; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data