title: Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review.
abstract: Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery.
  
  
  
  Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews.
  
  
  
  Six thousand one hundred eighty-seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third-party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter-term outpatient). Out-of-pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one-third of studies. Body-contouring surgery included in only 14%. One study evaluated long-term waitlisted patients. Surgery was cost-effective/cost-saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent.
  
  
  
  There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Campbell
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Venn
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Neil
authors.affiliation: Department of Health and Human Services, Hobart, Tasmania, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Hensher
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Sharman
authors.affiliation: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Palmer
mesh_terms: D050110:Bariatric Surgery / Q000191:economics*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000601:surgery; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D009765:Obesity / Q000191:economics / Q000601:surgery; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results
keywords: Bariatric/metabolic surgery; body contouring surgery; diabetes; health economic evaluation; waiting list