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Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review


Campbell, JA and Venn, A and Neil, A and Hensher, M and Sharman, M and Palmer, AJ, Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review, Obesity Reviews, 17, (9) pp. 850-894. ISSN 1467-7881 (2016) [Refereed Article]

Copyright Statement

Copyright 2016 World Obesity

DOI: doi:10.1111/obr.12424


BACKGROUND: Health economic evaluations inform healthcare resource allocation decisions for treatment options for obesity including bariatric/metabolic surgery. As an important advance on existing systematic reviews, we aimed to capture, summarize and synthesize a diverse range of economic evaluations on bariatric surgery.

METHODS: Studies were identified by electronic screening of all major biomedical/economic databases. Studies included if they reported any quantified health economic cost and/or consequence with a measure of effect for any type of bariatric surgery from 1995 to September 2015. Study screening, data extraction and synthesis followed international guidelines for systematic reviews.

RESULTS: Six thousand one hundred eighty-seven studies were initially identified. After two levels of screening, 77 studies representing 17 countries (56% USA) were included. Despite study heterogeneity, common themes emerged, and important gaps were identified. Most studies adopted the healthcare system/third-party payer perspective; reported costs were generally healthcare resource use (inpatient/shorter-term outpatient). Out-of-pocket costs to individuals, family members (travel time, caregiving) and indirect costs due to lost productivity were largely ignored. Costs due to reoperations/complications were not included in one-third of studies. Body-contouring surgery included in only 14%. One study evaluated long-term waitlisted patients. Surgery was cost-effective/cost-saving for severely obese with type 2 diabetes mellitus. Study quality was inconsistent.

DISCUSSION: There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m2 or long-term waitlisted) for surgery.

Item Details

Item Type:Refereed Article
Keywords:Bariatric/metabolic surgery, body contouring surgery, diabetes, health economic evaluation, waiting list
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Campbell, JA (Dr Julie Campbell)
UTAS Author:Venn, A (Professor Alison Venn)
UTAS Author:Neil, A (Associate Professor Amanda Neil)
UTAS Author:Sharman, M (Dr Melanie Sharman)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:110133
Year Published:2016
Web of Science® Times Cited:13
Deposited By:Menzies Institute for Medical Research
Deposited On:2016-07-14
Last Modified:2020-12-13

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