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Cited by 1,066Bariatric Surgery and OutcomesBody Contouring and SurgeryObesity, Physical Activity, Diet

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The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

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Picot, J, Jones, J, Colquitt, JL, Gospodarevskaya, E, Loveman, E, Baxter, L, Clegg, AJ·2009·Health Technology Assessment
DOI 10.3310/hta13410
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Abstract

OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. DATA SOURCES: Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. REVIEW METHODS: Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity. RESULTS: A total of 5386 references were identified of which 26 were included in the clinical effectiveness review: three randomised controlled trials (RCTs) and three cohort studies compared surgery with non-surgical interventions and 20 RCTs compared different surgical procedures. Bariatric surgery was a more effective intervention for weight loss than non-surgical options. In one large cohort study weight loss was still apparent 10 years after surgery, whereas patients receiving conventional treatment had gained weight. Some measures of QoL improved after surgery, but not others. After surgery statistically fewer people had metabolic syndrome and there was higher remission of Type 2 diabetes than in non-surgical groups. In one large cohort study the incidence of three out of six comorbidities assessed 10 years after surgery was significantly reduced compared with conventional therapy. Gastric bypass (GBP) was more effective for weight loss than vertical banded gastroplasty (VBG) and adjustable gastric banding (AGB). Laparoscopic isolated sleeve gastrectomy (LISG) was more effective than AGB in one study. GBP and banded GBP led to similar weight loss and results for GBP versus LISG and VBG versus AGB were equivocal. All comparisons of open versus laparoscopic surgeries found similar weight losses in each group. Comorbidities after surgery improved in all groups, but with no significant differences between different surgical interventions. Adverse event reporting varied; mortality ranged from none to 10%. Adverse events from conventional therapy included intolerance to medication, acute cholecystitis and gastrointestinal problems. Major adverse events following surgery, some necessitating reoperation, included anastomosis leakage, pneumonia, pulmonary embolism, band slippage and band erosion. Bariatric surgery was cost-effective in comparison to non-surgical treatment in the reviewed published estimates of cost-effectiveness. However, these estimates are likely to be unreliable and not generalisable because of methodological shortcomings and the modelling assumptions made. Therefore a new economic model was developed. Surgical management was more costly than non-surgical management in each of the three patient populations analysed, but gave improved outcomes. For morbid obesity, incremental cost-effectiveness ratios (ICERs) (base case) ranged between 2000 pounds and 4000 pounds per QALY gained. They remained within the range regarded as cost-effective from an NHS decision-making perspective when assumptions for de

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  12. to (clinical trial, phase iii or clinical trial, phase iv or clinical trial or comparative study or controlled clinical trial or evaluation studies or guideline or meta analysis or multicenter study or practice guideline or randomized controlled trial or "scientific integrity review" or technical report or twin study or validation studies) (555) 56 Cohort Studies/(66145) 57 Randomized Controlled Trial/(150030) 58 Prospective Studies/(156648) 59 Evaluation Studies/(96370) 60

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Metadata

Authors
Picot, J., Jones, J., Colquitt, J., Gospodarevskaya, E., Loveman, E., Baxter, L., & Clegg, A.
Affiliations
University of Southampton (GB)
Corresponding author
Picot, J
ORCID
Venue
Health Technology Assessment
Publisher
National Institute for Health and Care Research
Published
2009-09
Volume
13
Issue
41
Pages
1-190, 215
ISSN
  • 1366-5278 (ISSN-L)
  • 2046-4924
DOI
10.3310/hta13410
OpenAlex
W2169611151
Cited by
1,066
References
157
Citations by year
2026: 20 · 2025: 32 · 2024: 59 · 2023: 34 · 2022: 38 · 2021: 44 · 2020: 63 · 2019: 59 · 2018: 70 · 2017: 82 · 2016: 82 · 2015: 102 · 2014: 84 · 2013: 88 · 2012: 76
FWCI
11.02
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Technology Assessment (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Health Technology Assessment programme (08/06/01)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Keywords
bariatric surgery, obesity, weight loss, cost-effectiveness, clinical effectiveness, laparoscopic bariatric surgery, obesity-related comorbidities, type 2 diabetes, quality of life, morbidity and mortality, economic evaluation, body mass index, non-surgical interventions, economic models, cost-utility analysis, cost-benefit analysis
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Obesity, Outcome Assessment, Health Care, Bariatric Surgery, Young Adult

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