Cost-effectiveness of gastric band surgery for overweight but not obese adults with type 2 diabetes in the U.S

J Diabetes Complications. 2017 Jul;31(7):1139-1144. doi: 10.1016/j.jdiacomp.2017.04.009. Epub 2017 Apr 13.

Abstract

Aim: To determine the cost-effectiveness of gastric band surgery in overweight but not obese people who receive standard diabetes care.

Method: A microsimulation model (United Kingdom Prospective Diabetes Study outcomes model) was used to project diabetes outcomes and costs from a two-year Australian randomized trial of gastric band (GB) surgery in overweight but not obese people (BMI 25 to 30kg/m2) on to a comparable population of U.S. adults from the National Health and Nutrition Examination Survey (N=254). Estimates of cost-effectiveness were calculated based on the incremental cost-effectiveness ratios (ICERs) for different treatment scenarios. Costs were inflated to 2015 U.S. dollar values and an ICER of less than $50,000 per QALY gained was considered cost-effective.

Results: The incremental cost-effectiveness ratio for GB surgery at two years exceeded $90,000 per quality-adjusted life year gained but decreased to $52,000, $29,000 and $22,000 when the health benefits of surgery were assumed to endure for 5, 10 and 15 years respectively. The cost-effectiveness of GB surgery was sensitive to utility gained from weight loss and, to a lesser degree, the costs of GB surgery. However, the cost-effectiveness of GB surgery was affected minimally by improvements in HbA1c, systolic blood pressure and cholesterol.

Conclusions: GB surgery for overweight but not obese people with T2D appears to be cost-effective in the U.S. setting if weight loss endures for more than five years. Health utility gained from weight loss is a critical input to cost-effectiveness estimates and therefore should be routinely measured in populations undergoing bariatric surgery.

Keywords: Bariatric surgery; Cost-effectiveness; Gastric band surgery; Overweight but not obese; Type 2 diabetes.

MeSH terms

  • Australia
  • Bariatric Surgery* / economics
  • Body Mass Index
  • Combined Modality Therapy / economics
  • Cost of Illness
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / economics
  • Diabetes Mellitus, Type 2 / therapy
  • Health Care Costs
  • Humans
  • Middle Aged
  • Models, Economic*
  • Nutrition Surveys
  • Overweight / complications
  • Overweight / economics
  • Overweight / surgery*
  • Overweight / therapy
  • Quality of Life
  • Randomized Controlled Trials as Topic
  • United States
  • Weight Loss