title: Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model.
abstract: BACKGROUND
  The objective of the present study was to evaluate the cost-utility of bariatric surgery in a lifetime horizon from a Swedish health care payer perspective.
  
  
  METHODS
  A decision analytic model using the Markov process was developed covering cardiovascular diseases, type 2 diabetes, and surgical complications. Clinical effectiveness and safety were based on the literature and data from the Scandinavian Obesity Surgery Registry. Gastric bypass, sleeve gastrectomy, and gastric banding were included in the analysis. Cost data were obtained from Swedish sources.
  
  
  RESULTS
  Bariatric surgery was cost saving in comparison with conservative management. It also led to a substantial reduction in lifetime risk of events: from a 16 % reduction in the risk of transient ischaemic attacks to a 62 % reduction in the incidence of type 2 diabetes. Over a lifetime, surgery led to savings of euro 8408 and generated an additional 0.8 years of life and 4.1 quality-adjusted life years (QALYs) per patient, which translates into gains of 32,390 quality-adjusted person-years and savings of euro 66 million for the cohort, operated in 2012. Analysis of the consequences of a 3-year delay in surgery provision showed that the overall lifetime cost of treatment may be increased in patients with diabetes or a body mass index >40 kg/m(2). Delays in surgery may also lead to a loss of clinical benefits: up to 0.6 life years and 1.2 QALYs per patient over a lifetime.
  
  
  CONCLUSIONS
  Bariatric surgery, over a lifetime horizon, may lead to significant cost savings to health care systems in addition to the known clinical benefits.
authors: Synergus AB, Svardvagen 19, 182 33, Danderyd, Sweden, oleg.borisenko@synergus.com.
authors: Oleg
authors: O
authors: Borisenko
authors: Daniel
authors: D
authors: Adam
authors: Peter
authors: P
authors: Funch-Jensen
authors: Ahmed R
authors: AR
authors: Ahmed
authors: Rongrong
authors: R
authors: Zhang
authors: Zeynep
authors: Z
authors: Colpan
authors: Jan
authors: J
authors: Hedenbro
mesh_terms: D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control; D005060:Europe; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000517:prevention & control; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D019057:Quality-Adjusted Life Years; D014850:Waiting Lists
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