5- and 10-Year Cost-Effectiveness of Bariatric Surgery in Super Obese, Middle-Aged Patients: A United States Perspective

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Objective: The purpose of this capstone project is to evaluate the near- and mid-term cost-effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) in middle-aged (41 to 50 years old), super obese (BMI ≥ 50) patients from a United States perspective.

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Obesity is a risk factor for many chronic conditions and diseases, such as diabetes, cardiovascular disorders, musculoskeletal disorders, and cancer. Super obese patients (BMI ≥ 50 kg/m2)are often at higher risks for these conditions and diseases, often with mobility issues that make it difficult to lose weight through traditional means, such as diet and exercise. The objective of this capstone project was to develop a state-transition (Markov) model representing the 5- and 10-year post-operative clinical pathway of super obese bariatric surgery patients. The cost-effectiveness of LRYGB bariatric surgery versus no surgery was projected for the treatment of super obesity (BMI ≥ 50 kg/m2). The model focuses on changes in BMI and surgical-related complications to estimate lifetime cost, survival, and health-related quality of life (HRQoL). At 5- and 10-year time horizons in the base case model, LRYGB was cost-effective with higher QALYs [5 years: 0.3896 QALY; 10 years: 0.8863 QALY] and costs [5 years: $10,831; 10 years: ($848)] than non-operative management. Incremental cost-effectiveness ratios [5 years: $27,799/QALY; 10 years: $957/QALY] were below the $50,000 willingness to pay threshold. Deterministic sensitivity analysis showed the model results are very sensitive to utility estimates for super obese and morbidly obese patients, as well as operative costs. Probabilistic sensitivity analysis demonstrated that LRYGB is cost-effective at 5 years [$33,343/QALY; 55.9% of simulations cost-effective] and 10 years [$37,607/QALY; 66.6% of simulations cost-effective] with a willingness to pay threshold of $50,000/QALY. This model demonstrates the cost-effectiveness of LRYGB surgery versus non-operative medical treatment in super obese, middle-aged patients, an important subpopulation with patient access limitations to bariatric surgery.



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