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Original Investigation
October 26, 2016

Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity

Author Affiliations
  • 1Institute for Technology Assessment, Massachusetts General Hospital, Boston
  • 2Division of Gastroenterology, Massachusetts General Hospital, Boston
  • 3Now at Yale School of Medicine, New Haven, Connecticut
  • 4Harvard Medical School, Boston, Massachusetts
  • 5Now at Department of Surgery, Boston University, Boston, Massachusetts
JAMA Surg. Published online October 26, 2016. doi:10.1001/jamasurg.2016.3640
Key Points

Question  Is bariatric surgery a cost-effective treatment for adolescents with severe obesity?

Findings  In this cost-effectiveness analysis, a mathematical state transition model was used to determine that bariatric surgery has an incremental cost-effectiveness ratio of $154 684 per quality-adjusted life-year (QALY) when assessed over 3 years, $114 078 per QALY over 4 years, and $91 032 per QALY over 5 years. Thus, bariatric surgery is cost-effective at 5 years using a willingness-to-pay threshold of $100 000 per QALY.

Meaning  This study underscores the need for long-term clinical trials in adolescents with at least 5 years of follow-up data that capture financial and quality-of-life end points.

Abstract

Importance  Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited.

Objective  To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study.

Design, Setting, and Patients  A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) 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. Cohort demographic information—of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female—surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed.

Main Outcomes and Measures  Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness.

Results  After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30 747, yielding an unfavorable ICER of $154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $114 078 per QALY and became cost-effective by 5 years with an ICER of $91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses.

Conclusions and Relevance  Bariatric surgery incurs substantial initial cost and morbidity. We found that surgery could be a cost-effective treatment for adolescents with severe obesity if assessed over a time horizon of 5 years. Our study underscores the need for long-term clinical trials in adolescents with at least 5 years of follow-up data that capture financial and quality-of-life end points.

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