Obesity Facts (Jun 2017)

Cost-Utility Analysis of Bariatric Surgery in Italy: Results of Decision-Analytic Modelling

  • Marcello Lucchese,
  • Oleg Borisenko,
  • Lorenzo Giovanni Mantovani,
  • Paolo Angelo Cortesi,
  • Giancarlo Cesana,
  • Daniel Adam,
  • Elisabeth Burdukova,
  • Vasily Lukyanov,
  • Nicola Di Lorenzo

DOI
https://doi.org/10.1159/000475842
Journal volume & issue
Vol. 10, no. 3
pp. 261 – 272

Abstract

Read online

Objective: To evaluate the cost-effectiveness of bariatric surgery in Italy from a third-party payer perspective over a medium-term (10 years) and a long-term (lifetime) horizon. Methods: A state-transition Markov model was developed, in which patients may experience surgery, post-surgery complications, diabetes mellitus type 2, cardiovascular diseases or die. Transition probabilities, costs, and utilities were obtained from the Italian and international literature. Three types of surgeries were considered: gastric bypass, sleeve gastrectomy, and adjustable gastric banding. A base-case analysis was performed for the population, the characteristics of which were obtained from surgery candidates in Italy. Results: In the base-case analysis, over 10 years, bariatric surgery led to cost increment of EUR 2,661 and generated additional 1.1 quality-adjusted life years (QALYs). Over a lifetime, surgery led to savings of EUR 8,649, additional 0.5 life years and 3.2 QALYs. Bariatric surgery was cost-effective at 10 years with an incremental cost-effectiveness ratio of EUR 2,412/QALY and dominant over conservative management over a lifetime. Conclusion: In a comprehensive decision analytic model, a current mix of surgical methods for bariatric surgery was cost-effective at 10 years and cost-saving over the lifetime of the Italian patient cohort considered in this analysis.

Keywords