title: Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.
abstract: To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category.
  
  
  
  A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY.
  
  
  
  In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time.
  
  
  
  Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK. Electronic address: martin.gulliford@kcl.ac.uk.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK; National Institutes for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK.
authors.forename: Toby
authors.initials: T
authors.lastname: Prevost
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Booth
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Fildes
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Littlejohns
authors.affiliation: Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Reddy
authors.affiliation: Department of Surgery, St George's University Hospital National Health Service Foundation Trust, London, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Khan
authors.affiliation: Department of Social Policy, London School of Economics and Political Science, London, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rudisill
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D050110:Bariatric Surgery / Q000191:economics*; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003863:Depression / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017059:Models, Econometric; D009765:Obesity / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology* / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D012959:Socioeconomic Factors; D006113:United Kingdom; D055815:Young Adult
keywords: bariatric surgery; cost-effectiveness analysis; diabetes mellitus; obesity