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Bariatric surgery is cost-effective

Bariatric surgery is cost-effective treatment for patient with T2DM

Researchers stated that these results suggest that bariatric surgery will start to be cost-effective at seven years after the procedure

Performing bariatric surgery in patients with morbid obese with type 2 DM is a cost-effective strategy in Thailand, according to researchers from King Chulalongkorn Memorial Hospital (KCMH) and Thammasat University, Bangkok, Thailand. The authors note that although the evidence suggests that bariatric surgery is a successful long-term treatment in patients with morbid obese with type 2 DM, it is an expensive procedure with additional costs possible in the months following surgery. Therefore, they wanted to assess whether bariatric surgery is cost-effective in this group of patients. 

The study, ‘Cost-Effectiveness Evaluation of Bariatric Surgery for Morbidly Obese with Diabetes Patients in Thailand’, published in the Journal of Obesity, was established to analyse the cost-effectiveness of bariatric surgery vs. ordinary treatment for diabetes control in patients with morbid obese with type 2 DM.

The researchers collected data at 6-month and 1-year periods including the demographic data, types of bariatric surgery, clinical data including BMI and HbA1C, and utilisation data for all diabetes status outcomes. Healthcare costs were estimated for direct (bariatric surgery fee, diabetes medication fee, cost of supplementation and cost of complication management) and indirect medical costs (referred to productivity loss due to complication).

The valuation of cost was based on an estimated cost incurred by patients treated at KCMH in each diabetes status outcome and Thai Food and Drug control Administration data. In diabetes remission, costs were assumed from one-time cost of bariatric surgery and annual cost of supplementation. In improved and persistent diabetes, costs were estimated from an incremental medication cost used for diabetes control. For uncontrolled diabetes, a total cost was accumulated from the cost of all antidiabetic drugs use and the cost of all complication management.

Effectiveness measurement included both short-term and long-term outcomes. For short-term outcomes including 1-year diabetes status, BMI, and HbA1C reduction, data were obtained from retrospective analysis. For long-term outcomes, data of probability of diabetes relapse, transition probability of the diabetes state, life-year gained, and utility were reviewed from published literature.

All costs and utility data were adjusted to 2017 price using Thailand Consumer Price Index (CPI) and presented in Thai baht (THB). All future costs were discounted at an annual rate of 3%.

Cost-effectiveness was assessed by the calculated incremental cost-effectiveness ratios (ICERs). ICERs in terms of cost per quality-adjusted life-year (QALY), cost per life-year gained, and cost per clinical benefits from BMI and HbA1C reduction were used in the model. The threshold for considering cost-effectiveness of bariatric surgery recommended by Thailand health technology acceptance guideline recommendation 2016 is accounted for one to three folds of gross domestic product (GDP) per capita which is around 200,000 THB per QALY.


A total of 73 patients were included in the analysis, 43 (58.9%) were women and the mean (standard deviation, SD) age was 41.8 (12.2) years. Roux-en-Y gastric bypass (RYGB) surgery was performed in 45 (61.6%) patients. At one year after bariatric surgery compared with baseline, 61 (83.6%) patients had diabetes remission, mean (SD) BMI was 36.9 (8.9) vs. 50.9 (10.9)  (p<0.001), and mean (SD) HbA1C was 5.8 (1.4)% vs. 7.5 (1.9)% (p<0.001). Probability of diabetes remission at one year after bariatric surgery was 0.8356.

Incremental cost per one unit decrease of HbA1C and BMI was 75,251.61 and 9,533.66 THB, respectively. Discounted incremental cost-utility ratios was 26,907.76 THB/QALY. Therefore, the researchers stated that these results suggest that bariatric surgery will start to be cost-effective at seven years after the procedure.

The result from sensitivity analysis showed no change of discount rate, diabetes status, utility of the diabetes state, cost of diabetes treatment and cost of bariatric surgery over the threshold, in which the cost of DM treatment has the highest impact on the model.

“In our analysis, bariatric surgery was found to be a cost-effectiveness option based on incremental cost per QALY at around 27,000 THB which is below Thailand’s threshold,” the researcher noted. “…the result found in our study was consistent with previous cost-effectiveness study of bariatric surgery in other countries.”

They researchers concluded that the use of bariatric surgery in patients with morbid obese with type 2 DM is considered as the cost-effectiveness strategy in Thailand’s context.

To access this paper, please click here

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