Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model
<p><strong>Objectives</strong> To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m<sup>2</sup>), who are more at risk of obesity related diseases.</p> <p><strong>Methods<...
| Main Authors: | , , , , , , , , , , , , |
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| Other Authors: | |
| Format: | Journal article |
| Language: | English |
| Published: |
Springer Nature
2021
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| _version_ | 1797111473280909312 |
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| author | Boyers, D Retat, L Jacobsen, E Avenell, A Aveyard, P Corbould, E Jaccard, A Cooper, D Robertson, C Aceves-Martins, M Xu, B Skea, Z de Bruin, M |
| author2 | REBALANCE team |
| author_facet | REBALANCE team Boyers, D Retat, L Jacobsen, E Avenell, A Aveyard, P Corbould, E Jaccard, A Cooper, D Robertson, C Aceves-Martins, M Xu, B Skea, Z de Bruin, M |
| author_sort | Boyers, D |
| collection | OXFORD |
| description | <p><strong>Objectives</strong> To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m<sup>2</sup>), who are more at risk of obesity related diseases.</p>
<p><strong>Methods</strong> An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.</p>
<p><strong>Results</strong> RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.</p>
<p><strong>Conclusions</strong> RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.</p> |
| first_indexed | 2024-03-07T08:09:23Z |
| format | Journal article |
| id | oxford-uuid:4722d3a9-2460-4d79-9892-f40f7d2bb891 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:09:23Z |
| publishDate | 2021 |
| publisher | Springer Nature |
| record_format | dspace |
| spelling | oxford-uuid:4722d3a9-2460-4d79-9892-f40f7d2bb8912023-11-21T17:20:56ZCost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis modelJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:4722d3a9-2460-4d79-9892-f40f7d2bb891EnglishSymplectic ElementsSpringer Nature2021Boyers, DRetat, LJacobsen, EAvenell, AAveyard, PCorbould, EJaccard, ACooper, DRobertson, CAceves-Martins, MXu, BSkea, Zde Bruin, MREBALANCE team<p><strong>Objectives</strong> To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m<sup>2</sup>), who are more at risk of obesity related diseases.</p> <p><strong>Methods</strong> An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.</p> <p><strong>Results</strong> RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.</p> <p><strong>Conclusions</strong> RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.</p> |
| spellingShingle | Boyers, D Retat, L Jacobsen, E Avenell, A Aveyard, P Corbould, E Jaccard, A Cooper, D Robertson, C Aceves-Martins, M Xu, B Skea, Z de Bruin, M Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title | Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title_full | Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title_fullStr | Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title_full_unstemmed | Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title_short | Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model |
| title_sort | cost effectiveness of bariatric surgery and non surgical weight management programmes for adults with severe obesity a decision analysis model |
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