title: Bariatric surgery as a means to decrease mortality in women with type I endometrial cancer - An intriguing option in a population at risk for dying of complications of metabolic syndrome.
abstract: OBJECTIVE
  To estimate the cost-effectiveness and utility of a strategy of offering weight loss surgery (WLS) to women with low risk stage I endometrial cancer (EC) and BMI≥40kg/m(2).
  
  
  METHODS
  A modified Markov state transition model was designed to compare routine care to WLS for women with low risk stage I endometrioid EC, age<70, with a mean BMI 40. A time horizon of 15years was used to simulate the overall survival (OS) of 96,232 women treated from 1988-2010 from SEER*Stat data. To simulate the effects of WLS on OS, a hazard ratio (0.76, 95% CI 0.59-0.99) representing the OS improvement achieved from this intervention (derived from a prospective trial) was modeled. We assumed that 90% of women undergoing bariatric procedures would experience a reduction in BMI. We assumed that 5% of women not undergoing WLS would achieve weight loss to a BMI of 35. Costs of treatment for obesity-related chronic diseases and quality of life (QOL)-related utilities were modeled from published reports.
  
  
  RESULTS
  The mean cost-effectiveness for each strategy was: $69,295 and 8.10 quality-adjusted life years (QALYs) for routine care versus $100,675 and 9.30 QALYs for WLS. WLS had an incremental cost-effectiveness ratio (ICER) of $26,080/QALY compared to routine care. At a willingness to pay threshold of $50,000/QALY, WLS was the strategy of choice in 100% of simulations.
  
  
  CONCLUSIONS
  WLS is a potentially cost-effective intervention in women with low risk, early stage EC, at least in part due to improved quality of life with weight reduction.
authors.affiliation: The Ohio State University Wexner Medical Center, Division of Gynecologic Oncology Columbus, OH, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Neff
authors.affiliation: Duke University Medical Center, Durham, NC, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.affiliation: Duke University Medical Center, Durham, NC, United States.
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
authors.affiliation: The Ohio State University Wexner Medical Center, Division of Gynecologic Oncology Columbus, OH, United States.
authors.forename: David M
authors.initials: DM
authors.lastname: O'Malley
authors.affiliation: The Ohio State University Wexner Medical Center, Division of Gynecologic Oncology Columbus, OH, United States. Electronic address: David.Cohn@osumc.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
mesh_terms: D050110:Bariatric Surgery / Q000191:economics / Q000379:methods*; D018269:Carcinoma, Endometrioid / Q000378:metabolism / Q000601:surgery*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000378:metabolism / Q000601:surgery*; D005260:Female; D006801:Humans; D008390:Markov Chains; D024821:Metabolic Syndrome / Q000378:metabolism / Q000601:surgery*; D008875:Middle Aged; D018803:Models, Economic; D009765:Obesity / Q000378:metabolism / Q000601:surgery*; D011788:Quality of Life; D016019:Survival Analysis
keywords: Endometrial cancer; Obesity; Weight loss surgery