Clinical studyCost-effectiveness of gastric bypass for severe obesity☆
Section snippets
Decision model and sample
We used a deterministic decision model (12) to compare the lifetime expected costs and outcomes between gastric bypass and no treatment of severe obesity from the payer perspective (Figure 1). Patients in each arm were assigned to health outcomes by rates, instead of drawn from distributions. The cost-effectiveness ratio was determined by dividing the difference in total lifetime medical cost by the difference in quality-adjusted life-years (QALYs). Cost and QALYs were discounted at 3% to
Base case analysis
In all risk subgroups, the cost-effectiveness ratios of gastric bypass versus no treatment were favorable, at less than $50,000 per QALY. In four risk subgroups representing the upper and lower bounds of the cost-effectiveness ratios (Table 3, Table 4, Figure 2), the ratios ranged from about $5000 to $16,100 per QALY for women and from about $10,000 to $35,600 per QALY for men, depending on age and initial body mass index. These variations suggest that gastric bypass is more cost-effective
Discussion
Our results suggest that gastric bypass is not cost saving from the payer perspective. However, the cost-effectiveness ratio estimates compare favorably with those of other accepted interventions and appear robust to parameter variation, especially among women and younger, more obese men (25). In comparison with no treatment, gastric bypass is a cost-effective alternative.
Our study sample comprised subjects who were severely obese but who did not have the chronic medical conditions typically
Acknowledgements
We thank Richard L. Atkinson, Dennis Fryback, Khin Mae Hla, and William Lawrence for their guidance in this analysis. We are grateful to Mokdad Ali for his assessment of the prevalence of severe obesity using the Behavior Risk Factor Surveillance System. We also thank Ralph Insinga and Deborah Topol for their thoughtful comments on earlier versions of the manuscript.
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This study was supported by a T32 institutional training grant (HS00083) from the Agency for Healthcare Research and Quality, Rockville, Maryland, to the University of Wisconsin Program in Population Health.