COST-EFFECTIVENESS

COST-EFFECTIVENESS

A 2009 Health Technology Assessment report in the UK showed bariatric surgery to be cost-e ff ective compared with non-surgical options. The incremental cost-e ff ectiveness ratio (ICER) compared with no surgery was between £2000 and with BMI ≥ 40 /uni00A0 kg/m over 20 years. For patients with BMI 2 between 30 and <40 /uni00A0 kg/m the ICER was £1367 per QALY gained. Regarding maximum willingness to pay , compared with non-surgical interventions, if a decision-maker is willing to pay £20 /uni00A0 000 for an additional QALY , then the probability of surgery being cost-e ff ective over a 20-year time horizon was reported as 100%. The ICERs are similar to the cost e ff ectiveness of stopping smoking and routine statin therapy for the primary prevention of cardiovascular disease. In practice it means that the cost of the opera tion is recouped within 1–2 years after surgery from reduced medication costs. All the cost-e ff ectiveness studies assess direct or indirect healthcare costs but not the additional benefits of surgery . Thus, return to paid work, coming o ff state benefits, improved functional capacity and quality of life are ‘add-ons’ that incur no cost. A systematic review including studies up to 2018 confirmed that bariatric surgery is cost saving over a lifetime. Medication costs for obesity-related comorbidities are substantially reduced after bariatric surgery in the shorter term.