Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review. (7th July 2016)

• Record Type: Journal Article
• Authors: Campbell, J. A.; Venn, A.; Neil, A.; Hensher, M.; Sharman, M.; Palmer, A. J.
• Is Part Of: Obesity reviews. Volume 17:Number 9(2016:Sep.)
• Page Start: 850
• Page End: 894
• Publication Date: 2016-07-07
• Subjects: Bariatric/metabolic surgery -- body contouring surgery -- diabetes -- health economic evaluation -- waiting list; Obesity -- Periodicals; 616.398005
• DOI: 10.1111/obr.12424
• Languages: English
• ISSNs: 1467-7881

Abstract

Summary: Background: Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery. Methods: Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews. Results: Six thousand one hundred eighty‐seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third‐party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter‐term outpatient). Out‐of‐pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one‐third of studies. Body‐contouring surgery included in only 14%. One study evaluated long‐term waitlisted patients. Surgery was cost‐effective/cost‐saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent. Discussion: There is a need for studies that assume a broader societal perspective (including out‐of‐pocket costs, costs to family and productivity losses) and longer‐term costs (capture reoperations/complications, waiting, body contouring), and consequences (health‐related quality‐of‐life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m 2 or long‐term waitlisted) for surgery. © 2016 World Obesity