RYGB and SG are cost-effective for adolescents with severe obesity

Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are cost-effective compared with no surgery for adolescents with severe obesity, according to a study by researchers from the Northwestern University Feinberg School of Medicine.

Dr John B Rode from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the ten-year cost effectiveness of metabolic and bariatric surgery for adolescents with severe obesity using published results from the Teen-Longitudinal Assessment of Bariatric Surgery study.

"Our study shows that over time, weight-loss surgery emerges as the most cost-effective option when we consider years of better health that it provides, compared to non-surgical management for teens with severe obesity," said Rode.

The economic evaluation used a microsimulation model of a cohort of 100,000 simulated adolescents to project the health and cost outcomes of no surgery, RYGB, and sleeve gastrectomy over ten years.

The population was a hypothetical cohort of 100 000 adolescents with the following baseline characteristics: age 17 years, body mass index 52.1, 75.0% female, 13.3% with type 2 diabetes, 4.9% with low ferritin, 37.2% with low vitamin D, and 0.4% with low vitamin B12. At 10 years, sleeve gastrectomy was projected to be the cost-effective strategy, with an ICER of $41 164 per QALY gained when compared with no surgery. RYGB yielded the most QALYs, although with a less favourable ICER of $557 751 per QALY gained compared with sleeve gastrectomy. However, in a direct comparison with no surgery, RYGB was estimated to be cost-effective, with an ICER of $50 271 per QALY gained. In sensitivity analyses, sleeve gastrectomy was consistently the cost-effective strategy.

The researchers concluded that in their economic evaluation of bariatric surgery for adolescents with severe obesity, both RYGB and SG were determined to be cost-effective when compared with no surgery. However, sleeve gastrectomy was estimated to be the cost-effective strategy over a ten-year time horizon when simultaneously comparing all three interventions. These findings complement established clinical evidence of the long-term benefits of metabolic and bariatric surgery, supporting its economic value.

The findings were reported in the paper, ‘A 10-Year Cost-Effectiveness Analysis of Metabolic and Bariatric Surgery in Adolescents’, published in JAMA Network Open. To access this paper, please click here