Cost Effectiveness of Bariatric Surgical Treatment Methods: A Systematic Review

Yıl 2023, , 1001 - 1017, 30.12.2023

Dolunay Özlem Zeybek , Vahit Yiğit

https://doi.org/10.18506/anemon.1355355

Öz

Obesity has become an epidemic today and has become one of the important public health problems. Pharmacological treatment, exercise, cognitive behavioural therapy, medical nutrition and bariatric surgery are used in the treatment of obesity. The aim of this study was to systematically identify and evaluate the national and international literature on the cost-effectiveness of bariatric surgery methods. In this context, a systematic search of electronic databases was conducted. Screening, data extraction, and critical assessment of methodological quality were evaluated according to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Incremental cost-effectiveness ratio (ICER) and cost per quality-adjusted life year (QALY) were interpreted using the outcome measure. A total of 448 articles were accessed and the full text of 164 articles was analysed. Within the framework of inclusion and exclusion criteria, 20 articles were included in the study. According to the studies in the literature, bariatric surgery is a low-cost or cost-saving treatment option in the long term. There is limited evidence about the long-term clinical effects and safety of bariatric surgery. Therefore, further studies in this context will significantly contribute to the results of cost-effectiveness studies.

Anahtar Kelimeler

Bariatric Surgery, Cost Effectiveness Analysis, Systematic Review

Bariyatrik Cerrahi Tedavi Yöntemlerinin Maliyet Etkililiği: Sistematik Bir İnceleme

Öz

Obezite günümüzde salgın haline gelerek önemli halk sağlığı sorunlarından biri olmuştur. Obezite tedavisinde farmakolojik tedavi, egzersiz, bilişsel davranışçı terapi, tıbbi beslenme ve bariyatrik cerrahi gibi yöntemler uygulanmaktadır. Bu çalışmanın amacı bariyatrik cerrahi yöntemlerinin maliyet etkililiği hakkındaki ulusal ve uluslararası literatürü sistematik olarak tanımlamak ve değerlendirmektir. Bu kapsamda elektronik veri tabanlarında sistematik bir araştırma yapılmıştır. Tarama, veri çıkarma, metodolojik kalitenin kritik değerlendirmesi Konsolide Sağlık Ekonomisi Değerlendirme Raporlama Standartları [Consolidated Health Economic Evaluation Reporting Standards (CHEERS)] göre değerlendirilmiştir. İlave maliyet-etkililik oranı (İMEO) ve kaliteye ayarlı yaşam yılı (QALY) başına maliyet sonuç ölçütü kullanılarak yorumlanmıştır. Araştırmada toplam 448 makaleye ulaşılmış ve 164 makalenin tam metni incelenmiştir. Dahil etme ve çıkarma kriterleri çerçevesinde 20 makale araştırma kapsamına alınmıştır. Literatürdeki çalışmalara göre bariyatrik cerrahi uzun zaman diliminde düşük maliyetli veya maliyet tasarrufu sağlayan bir tedavi seçeneği olduğunu göstermektedir. Bariyatrik cerrahinin uzun vadeli klinik etkileri ve güvenliği hakkında sınırlı kanıt bulunmaktadır. Bu nedenle bu kapsamda daha fazla çalışmanın yapılması maliyet-etkililik çalışmalarının sonuçlarına önemli derece katkıda bulunacaktır.

Anahtar Kelimeler

Bariyatrik Cerrahi, Maliyet Etkililik Analizi, Sistematik Tarama.

Kaynakça

• Alsumali, A., Eguale, T., Bairdain, S., and Samnaliev, M. (2018). Cost-Effectiveness analysis of bariatric surgery for morbid obesity. Obesity Surgery, 28(8), 2203–2214.
• An, S., Park, H. Y., Oh, S. H., Heo, Y., Park, S., Jeon, S. M., and Kwon, J. W. (2020). Cost-effectiveness of bariatric surgery for people with morbid obesity in South Korea. Obesity Surgery, 30(1), 256–266.
• Ara, R., and Braizer, J. (2014). Cost-effectiveness modeling using health state utility values. In Encyclopedia of Health Economics (1. Edition, pp. 130–138). Elsevier.
• Borisenko, O., Adam, D., Funch-Jensen, P., Ahmed, A. R., Zhang, R., Colpan, Z., and Hedenbro, J. (2015). Bariatric surgery can lead to net cost savings to health care systems: results from a comprehensive European decision analytic model. Obesity Surgery, 25(9), 1559–1568.
• Borisenko, O., Lukyanov, V., Debergh, I., and Dillemans, B. (2018). Cost-effectiveness analysis of bariatric surgery for morbid obesity in Belgium. Journal of Medical Economics, 21(4), 365–373. https://doi.org/10.1080/13696998.2017.1419958
• Borisenko, O., Lukyanov, V., Johnsen, S. P., and Funch-Jensen, P. (2017). Cost analysis of bariatric surgery in Denmark made with a decision-analytic model. Danish Medical Journal, 64(8).
• Borisenko, O., Lukyanov, V., and Ahmed, A. R. (2018). Cost–utility analysis of bariatric surgery. British Journal of Surgery, 105(10), 1328–1337.
• Borisenko, O., Mann, O., and Duprée, A. (2017). Cost-utility analysis of bariatric surgery compared with conventional medical management in Germany: A decision analytic modeling. BMC Surgery, 17(1).
• Briggs, A. H., and O’brien. (2001). The death of cost-minimization analysis? Health Economics, 10(2), 179–184. https://doi.org/10.1002/hec.584
• Campbell, J. A., Venn, A., Neil, A., Hensher, M., Sharman, M., and Palmer, A. J. (2016). Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 17(9), 850–894. https://doi.org/10.1111/obr.12424
• Campbell, J., McGarry, L. A., Shikora, S. A., Hale, B. C., Lee, J. T., and Weinstein, M. C. (2010). Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity. The American Journal of Managed Care, 16(7).
• Castilla, I., Mar, J., Valcárcel-Nazco, C., Arrospide, A., and Ramos-Goñi, J. M. (2014). Cost-Utility Analysis of Gastric Bypass for Severely Obese Patients in Spain. https://doi.org/10.1007/s11695-014-1304-0
• Chang, S. H., Stoll, C. R. T., Song, J., Varela, J. E., Eagon, C. J., and Colditz, G. A. (2014). The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surgery, 149(3), 275–287. https://doi.org/10.1001/JAMASURG.2013.3654
• Çelik, Y. (2016). Sağlık Ekonomisi (3. Baskı). Siyasal Baskı: Ankara.
• Drummond, M. F., Sculpher, M. J., Claxton, K., Stoddart, G. L., and Torrance, G. W. (2015). methods for the economic evaluation of health care programmes. Oxford University Press.
• Faria, G. R., Preto, J. R., and Costa-Maia, J. (2013). Gastric bypass is a cost-saving procedure: Results from a comprehensive markov model. Obesity Surgery, 23(4), 460–466. https://doi.org/10.1007/s11695-012-0816-8
• Fox-Rushby, J., and Cairns, J. (2005). Economic Evaluation (1. Edition). Open University Press.
• Gafni, A., and Birch S. (2006). Incremental Cost-Effectiveness Ratios (ICERs): The silence of the lambda. Social Science and Medicine, 62 (9): 2091-2100.
• Gerkens, S., Crott, R., Cleemput I., Thissen, J., Closon, M., Horsmans, Y., and Beguin, C. (2008). Comparison of three instruments assessing the quality of economics evaluations: a practial exercise on economic evaluations of the surgical treatment of obesity. International Journal of Technology Assesment in Health Care, 24(3): 318-325.
• Huserau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustowski, F., Briggs, A., Mauskopf, J., Loder, E., and CHEERS Task Force, (2013). Consolidated health economic evaluation reporting standards (cheers) statement. Cost Effectiveness and Resource Allocation, 11 (1).
• Jacobsen, E., Boyers, D., Manson, P. et al. A systematic review of the evidence for non-surgical weight management for adults with severe obesity: what is cost effective and what are the implications for the design of health services? Curr Obes Rep 11, 356–385 (2022). https://doi.org/10.1007/s13679-022-00483-z
• James, R., Salton, R. I., Byrnes, J. M., and Scuffham, P. A. (2017). Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia. Surgery for Obesity and Related Diseases, 13(12), 2012–2020.
• Klebanoff, M. J., Chhatwal, J., Nudel, J. D., Corey, K. E., Kaplan, L. M., and Hur, C. (2017). Cost-effectiveness of bariatric surgery in adolescents with obesity. JAMA Surgery, 152(2), 136–141. https://doi.org/10.1001/jamasurg.2016.3640
• Kobelt, G. (2010). Sağlık Ekonomisi: Ekonomik Değerlendirmeye Giriş, (2.Edition). Irisal.
• Lester, E. L. W., Padwal, R. S., Birch, D. W., Sharma, A. M., So, H., Ye, F., and Klarenbach, S. W. (2021). The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis. CMAJ Open, 9(2), E673–E679.
• Lobstein, T., Brinsden, H., Neveux, M., Cavalcanti, O. B., Barquera, S., Baur, L., Busch, V., Buse, K., Dietz, B., French, A., Leach, R. J., Opzeeland, B. van, Powis, J., Ralston, J., Roberts, K., Rudolf, M., Swinburn, B., Trayner, R., and Wilding, J. (2022). World Obesity Atlas 2022. In World Obesity Federation 2022 (Issue March).
• https://www.worldobesityday.org/resources/entry/world-obesity-atlas-2022
• Louwagie, P., Neyt, M., Dossche, D., Camberlin, C., B, Geuzendam, B. T., Heede, K. V. D., and Brabandt, H. V. (2019). Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness. Health Technology Assessment (HTA) Brussels: Belgian Health Care Knowledge Centre (KCE). https://kce.fgov.be/sites/default/files/atoms/files/KCE_316_Bariatric_surgery_Report.pdf
• Lucchese, M., Borisenko, O., Mantovani, L. G., Cortesi, P. A., Cesana, G., Adam, D., Burdukova, E., Lukyanov, V., and di Lorenzo, N. (2017). Cost-utility analysis of bariatric surgery in Italy: results of decision-analytic modelling. Obesity Facts, 10(3), 261–272. https://doi.org/10.1159/000475842
• Mäklin, S., Malmivaara, A., Linna, M., Victorzon, M., Koivukangas, V., and Sintonen, H. (2011). Cost-utility of bariatric surgery for morbid obesity in Finland. British Journal of Surgery, 98(10), 1422–1429. https://doi.org/10.1002/bjs.7640
• Ministry of Health. (2022). Sağlık İstatistikleri Yıllığı 2020. Ankara.
• Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., Altman, D., Antes, G., Atkins, D., Barbour, V., Barrowman, N., Berlin, J. A., Clark, J., Clarke, M., Cook, D., D’Amico, R., Deeks, J. J., Devereaux, P. J., Dickersin, K., Egger, M., Ernst, E., … Tugwell, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Medicine, 6(7). https://doi.org/10.1371/JOURNAL.PMED.1000097
• O’Brien, P. E., Hindle, A., Brennan, L., Skinner, S., Burton, P., Smith, A., Crosthwaite, G., and Brown, W. (2019). Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. obesity surgery, 29(1), 3–14. https://doi.org/10.1007/S11695-018-3525-0
• Okunogbe, A., Nugent, R., Spencer, G., Ralston, J., and Wilding, J. (2021). Economic impacts of overweight and obesity: current and future estimates for eight countries. BMJ Global Health, 6, 6351. https://doi.org/10.1136/bmjgh-2021-006351
• Panca, M., Viner, R. M., White, B., Pandya, T., Melo, H., Adamo, M., Batterham, R., Christie, D., Kinra, S., and Morris, S. (2018). Cost-effectiveness of bariatric surgery in adolescents with severe obesity in the UK. Clinical Obesity, 8(2), 105–113.
• Picot, J., Jones, J., Colquitt, J. L., Gospodarevskaya, E., Loveman, E., Baxter, L., and Clegg, A. J. (2009). The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: A systematic review and economic evaluation. Health Technology Assessment, 13(41). https://doi.org/10.3310/hta13410
• Rudmik L, Drummond M. Health economic evaluation: important principles and methodology. Laryngoscope. 2013 Jun;123(6):1341-7. doi: 10.1002/lary.23943. Epub 2013 Mar 11. PMID: 23483522.
• Salem, L., Devlin, A., Sullivan, S. D., and Flum, D. R. (2008). Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surgery for Obesity and Related Diseases, 4(1), 26–32. https://doi.org/10.1016/j.soard.2007.09.009
• Sanchez-Santos, R., Padin, E. M., Adam, D., Borisenko, O., Fernandez, S. E., Dacosta, E. C., Fernández, S. G., Vazquez, J. T., de Adana, J. C. R., and de la Cruz Vigo, F. (2018). Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis. Expert Review of Pharmacoeconomics and Outcomes Research, 18(3), 305–314. https://doi.org/10.1080/14737167.2018.1407649
• Saygın Avşar, T., Yiğit, V., Yiğit, A., Arı, H., Tecirli, G., Dilmaç, E., and Huserau, D., (2023). Konsolide Sağlik Ekonomisi Değerlendirme Raporlama Standartları Türkçe: Sağlık Hizmetlerinin Ekonomik Değerlendirmesinde Raporlama Standartlarının Türkiye Uyarlaması. Türkiye Klinikleri Sağlık Bilimleri Dergisi, 1-17.
• Sinha, A., Sing, P., and Bhat, S., (2016). Are we operating too late? mortality analysis and stochastic simulation of costs associated with bariatric surgery: reconsidering the BMI threshold. Obesity Surgery, 26 (1):219-228.
• Song, H. J., Kwon, J. W., Kim, Y. J., Oh, S. H., Heo, Y., and Han, S. M. (2013). bariatric surgery for the treatment of severely obese patients in South Korea - is it cost effective? Obesity Surgery, 23(12), 2058–2067.
• Swinburn, B. A., Sacks, G., Hall, K. D., McPherson, K., Finegood, D. T., Moodie, M. L., and Gortmaker, S. L. (2011). The global obesity pandemic: shaped by global drivers and local environments. Lancet (London, England), 378(9793), 804–814. https://doi.org/10.1016/S0140-6736(11)60813-1
• Tang, Q., Sun, Z., Zhang, N., Xu, G., Song, P., Xu, L., and Tang, W. (2016). Cost-effectiveness of bariatric surgery for type 2 diabetes mellitus. Medicine (United States), 95(20), 1–9. https://doi.org/10.1097/MD.0000000000003522
• TEMD. (2017). Obezite Tanı ve Tedavi Kılavuzu. Türkiye Endokrinoloji ve Metabolizma Derneği. Miki Matbaacılık San. ve Tic. Ltd. Şti, Ankara.
• TEMD. (2018). Bariyatrik Cerrahi̇ Kılavuzu. Miki Matbaacılık San. ve Tic. Ltd. Şti, Ankara.
• Tremmel M, Gerdtham U-G, Nilsson PM, Saha S. Economic burden of obesity: a systematic literature review. International Journal of Environmental Research and Public health. 2017; 14(4):435. https://doi.org/10.3390/ijerph14040435
• Wang, B. C. M., Wong, E. S., Alfonso-Cristancho, R., He, H., Flum, D. R., Arterburn, D. E., Garrison, L. P., and Sullivan, S. D. (2014). Cost-effectiveness of bariatric surgical procedures for the treatment of severe obesity. European Journal of Health Economics, 15(3), 253–263. https://doi.org/10.1007/s10198-013-0472-5
• Wang, Y. C., McPherson, K., Marsh, T., Gortmaker, S. L., and Brown, M. (2011). Health and economic burden of the projected obesity trends in the USA and the UK. Lancet (London, England), 378(9793), 815–825. https://doi.org/10.1016/S0140-6736(11)60814-3
• Wentworth, J., Dalziel, K., O’Brien, P., Burton, P., Shaba, F., Clarke, P., Laiteerapong, N., and Brown, W., (2017). Cost- effectiveness of gastric band surgery for overweight but not obese adult with type 2 diabetes In The U.S., Journal of Diabetes and its Complications, 31 (7): 1139-1144.
• Welbourn, R., Hollyman, M., Kinsman, R. et al. Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO global registry report 2018. OBES SURG 29, 782–795 (2019). https://doi.org/10.1007/s11695-018-3593-1. WHO. (2022). Obesity. (Erişim:01.06.2023). https://www.who.int/health-topics/obesity#tab=tab_1
• Xia, Q., Campbell, J. A., Ahmad, H., Si, L., de Graaff, B., and Palmer, A. J. (2020). Bariatric surgery is a cost-saving treatment for obesity—a comprehensive meta-analysis and updated systematic review of health economic evaluations of bariatric surgery. Obesity Reviews, 21(1), 1–15. https://doi.org/10.1111/obr.12932