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Adolescent bariatric surgery cost-effective after five years
In a study assessing the cost-effectiveness of bariatric surgery for adolescents with obesity using published results from the Teen-Longitudinal Assessment of Bariatric Surgery study, researchers have reported that while bariatric surgery was not cost-effective over a three-year time horizon, it could become cost-effective if assessed over a time horizon of give years.
"Our analysis indicates that it can also be cost-effective when assessed over a relatively short time horizon."
The study, ‘Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity’, was published online by JAMA Surgery, underlines the importance long-term clinical trials in adolescents with at least five years of follow-up data that capture financial and quality-of-life end points.
For this study, a model was created to compare two strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their BMI over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Demographic information of 228 patients included in the analysis: average age, 17 years; average BMI, 53; and 171 (75 percent) were female-surgery-related outcomes. A willingness-to-pay threshold of US$100,000 per quality-adjusted life-years was used to assess cost-effectiveness.
After three years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of US$30,747 yielding an unfavourable ICER of US$154,684 per QALY. When the clinical study results were extrapolated to four years, the ICER decreased to US$114,078 per QALY and became cost-effective by five years with an ICER of US$91,032 per QALY. Outcomes were robust in most one-way and probabilistic sensitivity analyses.
"At present, bariatric surgery is performed in approximately 1,000 adolescents per year. Increasing access to bariatric surgery in adolescents, even by a factor of 4, would hardly affect obesity prevalence on a population level," the authors write. "From an individual-patient perspective, though, bariatric surgery can result in life-altering weight loss, which not only leads to the resolution and prevention of disease but also allows patients to avoid the stigma, bullying, and isolation that often accompany severe obesity. As evidence supporting the safety and efficacy of bariatric surgery continues to accrue for the adolescent population, it will likely become a more accepted and commonly used therapeutic option. Our analysis indicates that it can also be cost-effective when assessed over a relatively short time horizon. Longer-term studies that track quality of life, weight loss, comorbidity resolution, and health care costs are needed to confirm our findings."