title: Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia.
abstract: BACKGROUND
  The uptake of bariatric surgery in Australia has been hampered by the lack of funding and lack of evidence on relative value for money.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of adjustable gastric banding (AGB), Roux-En-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) versus usual care (UC).
  
  
  METHODS
  Perspective of the Australian public healthcare system.
  
  
  METHODS
  A Markov model was constructed to simulate the costs and outcomes for 4 approaches to managing obesity. The base-case was a 30-year-old Australian female with a body-mass index>35. Subgroup analysis was conducted to account for the effect of diabetes as well as various differences in cohort characteristics. Uncertainty was characterised by one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  All bariatric surgeries were effective. The incremental cost-effectiveness ratios were similar at $24,454 for AGB, $22,645 for RYGB, and $27,523 for SG, compared with UC. At a willingness to pay threshold of $70,000 per quality-adjusted life year, the probabilities of being cost-effective were 64%, 75%, and 71% for AGB, RYGB, and SG, respectively. Subgroup analysis showed that bariatric procedures are less cost-effective for older cohorts. For those with diabetes, all the procedures were dominant in comparison with UC.
  
  
  CONCLUSIONS
  This model shows that all bariatric procedures are a cost-effective treatment for the management of obese patients. When given to a subgroup with diabetes, bariatric interventions become cost-saving.
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
authors.forename: Robbie
authors.initials: R
authors.lastname: James
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; City University, London, United Kingdom.
authors.forename: Ryan Ishmael
authors.initials: RI
authors.lastname: Salton
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
authors.forename: Joshua Michael
authors.initials: JM
authors.lastname: Byrnes
authors.affiliation: Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia. Electronic address: p.scuffham@griffith.edu.au.
authors.forename: Paul Anthony
authors.initials: PA
authors.lastname: Scuffham
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia; D050110:Bariatric Surgery / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
keywords: Bariatric; Cost-effectiveness; Cost-utility; Markov; Obesity