• Robbie James, Ryan Ishmael Salton, Joshua Michael Byrnes, and Paul Anthony Scuffham.
• Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
• Surg Obes Relat Dis. 2017 Dec 1; 13 (12): 2012-2020.

BackgroundThe uptake of bariatric surgery in Australia has been hampered by the lack of funding and lack of evidence on relative value for money.ObjectivesTo determine the cost-effectiveness of adjustable gastric banding (AGB), Roux-En-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) versus usual care (UC).SettingPerspective of the Australian public healthcare system.MethodsA Markov model was constructed to simulate the costs and outcomes for 4 approaches to managing obesity. The base-case was a 30-year-old Australian female with a body-mass index>35. Subgroup analysis was conducted to account for the effect of diabetes as well as various differences in cohort characteristics. Uncertainty was characterised by one-way and probabilistic sensitivity analyses.ResultsAll bariatric surgeries were effective. The incremental cost-effectiveness ratios were similar at $24,454 for AGB, $22,645 for RYGB, and $27,523 for SG, compared with UC. At a willingness to pay threshold of $70,000 per quality-adjusted life year, the probabilities of being cost-effective were 64%, 75%, and 71% for AGB, RYGB, and SG, respectively. Subgroup analysis showed that bariatric procedures are less cost-effective for older cohorts. For those with diabetes, all the procedures were dominant in comparison with UC.ConclusionThis model shows that all bariatric procedures are a cost-effective treatment for the management of obese patients. When given to a subgroup with diabetes, bariatric interventions become cost-saving.Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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