• Shane Keogh, Jarlath C Bolger, Sinead Brady, Ailin Rodgers, Mayilone Arumugasamy, and William B Robb.
• Department of Upper GI Surgery, Beaumont Hospital, Dublin 9, Ireland. Electronic address: shanekeogh@rcsi.ie.
• Surg Obes Relat Dis. 2018 Nov 1; 14 (11): 1670-1677.

BackgroundObesity is a chronic disease associated with significant morbidity and mortality. Bariatric surgery has been shown to significantly reduce both morbidity and mortality. Numerous surgical strategies exist, but the most frequently used worldwide are adjustable gastric banding, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB). It is not clear which of these strategies provides the optimal quality-of-life pay-off.ObjectiveModeled decision analysis allows comparison of different treatment interventions allowing for plausible differences in input variables. This facilitates establishment of the optimal intervention under numerous conditions.SettingUniversity Hospital, Ireland.MethodsModeled decision analysis was performed from the patient's perspective comparing best medical therapy, adjustable gastric banding, SG, and RYGB. Input variables were calculated based on previously published decision analyses and a systematic search of obesity-related literature. Utilities were based on previously published studies. One-way sensitivity analysis was performed. Sensitive variables underwent 3-way analysis.ResultsThe optimal treatment strategy in the base case was RYGB with a quality-adjusted life-year payoff (QALY) of 1.53 QALYs at 2 years postprocedure. Sleeve gastrectomy provided 1.49 QALYs. Medical therapy and adjustable gastric banding provided .98 and .96 QALYs, respectively. Rate of complications in RYGB and the utility of SG and RYGB proved sensitive. If complication rates are high, SG becomes the optimal strategy. Sensitive thresholds were established for the utility of SG and RYGB at .804 and .78, respectively.ConclusionSG and RYGB offer similar outcomes in terms of QALY payoffs. Decision making should be in line with institutional and patient preference.Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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