Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation

A. Clegg, J. Colquitt, M. Sidhu, Pamela Lee Royle, A. Walker

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

OBJECTIVE: To assess the clinical and cost effectiveness of surgery for people with morbid obesity.

DESIGN: A systematic review of randomised control trials (RCTs), prospective clinical trials and economic evaluations identified from 14 electronic databases ( including Medline, Cochrane library and Embase from their inception to October 2001), bibliographies and consultation with experts and manufacturers was performed to assess the clinical and cost effectiveness of different surgical procedures and nonsurgical management for morbid obesity. An economic evaluation was undertaken to assess cost effectiveness in the UK.

SUBJECTS: People diagnosed as morbidly obese, defined as a body mass index (BMI) ( weight in kilograms/ height in metres 2) >40 kg/m(2), or with a BMI > 35 kg/m(2) with serious comorbid disease, in whom previous nonsurgical interventions had failed.

MEASUREMENTS: The outcomes assessed included weight change, quality of life, peri- and postoperative morbidity and mortality, revision rates and obesity comorbidities. Cost effectiveness was modelled from these data and presented as cost per quality-adjusted life year ( QALY).

RESULTS: Included studies differed in methodological quality. Surgery resulted in a significantly greater loss of weight ( 23 - 37 kg more weight) than nonsurgical treatment, which was maintained to 8 years and led to improvements in quality of life and comorbidities. The economic evaluation of surgery compared with nonsurgical management suggested that surgery was cost effective at pound11 000 per QALY. Comparisons of the different types of surgery were equivocal.

CONCLUSION: Surgery for morbid obesity appears to be clinically and cost effective. Because of the nature of the evidence, particularly the uncertainty in the clinical and economic evaluations, it is difficult to distinguish between the different surgical procedures.

Original languageEnglish
Pages (from-to)1167-1177
Number of pages10
JournalInternational Journal of Obesity
Volume27
Issue number10
DOIs
Publication statusPublished - Oct 2003

Keywords

  • morbid
  • surgery
  • review
  • literature
  • model
  • economic
  • VERTICAL BANDED GASTROPLASTY
  • INTENTIONAL WEIGHT-LOSS
  • QUALITY-OF-LIFE
  • GASTRIC BYPASS
  • RANDOMIZED TRIAL
  • SUBJECTS SOS
  • JEJUNOILEAL BYPASS
  • SURGICAL-TREATMENT
  • BLOOD-PRESSURE
  • FOLLOW-UP

Cite this

Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. / Clegg, A.; Colquitt, J.; Sidhu, M.; Royle, Pamela Lee; Walker, A.

In: International Journal of Obesity, Vol. 27, No. 10, 10.2003, p. 1167-1177.

Research output: Contribution to journalArticle

Clegg, A. ; Colquitt, J. ; Sidhu, M. ; Royle, Pamela Lee ; Walker, A. / Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. In: International Journal of Obesity. 2003 ; Vol. 27, No. 10. pp. 1167-1177.
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T1 - Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation

AU - Clegg, A.

AU - Colquitt, J.

AU - Sidhu, M.

AU - Royle, Pamela Lee

AU - Walker, A.

PY - 2003/10

Y1 - 2003/10

N2 - OBJECTIVE: To assess the clinical and cost effectiveness of surgery for people with morbid obesity.DESIGN: A systematic review of randomised control trials (RCTs), prospective clinical trials and economic evaluations identified from 14 electronic databases ( including Medline, Cochrane library and Embase from their inception to October 2001), bibliographies and consultation with experts and manufacturers was performed to assess the clinical and cost effectiveness of different surgical procedures and nonsurgical management for morbid obesity. An economic evaluation was undertaken to assess cost effectiveness in the UK.SUBJECTS: People diagnosed as morbidly obese, defined as a body mass index (BMI) ( weight in kilograms/ height in metres 2) >40 kg/m(2), or with a BMI > 35 kg/m(2) with serious comorbid disease, in whom previous nonsurgical interventions had failed.MEASUREMENTS: The outcomes assessed included weight change, quality of life, peri- and postoperative morbidity and mortality, revision rates and obesity comorbidities. Cost effectiveness was modelled from these data and presented as cost per quality-adjusted life year ( QALY).RESULTS: Included studies differed in methodological quality. Surgery resulted in a significantly greater loss of weight ( 23 - 37 kg more weight) than nonsurgical treatment, which was maintained to 8 years and led to improvements in quality of life and comorbidities. The economic evaluation of surgery compared with nonsurgical management suggested that surgery was cost effective at pound11 000 per QALY. Comparisons of the different types of surgery were equivocal.CONCLUSION: Surgery for morbid obesity appears to be clinically and cost effective. Because of the nature of the evidence, particularly the uncertainty in the clinical and economic evaluations, it is difficult to distinguish between the different surgical procedures.

AB - OBJECTIVE: To assess the clinical and cost effectiveness of surgery for people with morbid obesity.DESIGN: A systematic review of randomised control trials (RCTs), prospective clinical trials and economic evaluations identified from 14 electronic databases ( including Medline, Cochrane library and Embase from their inception to October 2001), bibliographies and consultation with experts and manufacturers was performed to assess the clinical and cost effectiveness of different surgical procedures and nonsurgical management for morbid obesity. An economic evaluation was undertaken to assess cost effectiveness in the UK.SUBJECTS: People diagnosed as morbidly obese, defined as a body mass index (BMI) ( weight in kilograms/ height in metres 2) >40 kg/m(2), or with a BMI > 35 kg/m(2) with serious comorbid disease, in whom previous nonsurgical interventions had failed.MEASUREMENTS: The outcomes assessed included weight change, quality of life, peri- and postoperative morbidity and mortality, revision rates and obesity comorbidities. Cost effectiveness was modelled from these data and presented as cost per quality-adjusted life year ( QALY).RESULTS: Included studies differed in methodological quality. Surgery resulted in a significantly greater loss of weight ( 23 - 37 kg more weight) than nonsurgical treatment, which was maintained to 8 years and led to improvements in quality of life and comorbidities. The economic evaluation of surgery compared with nonsurgical management suggested that surgery was cost effective at pound11 000 per QALY. Comparisons of the different types of surgery were equivocal.CONCLUSION: Surgery for morbid obesity appears to be clinically and cost effective. Because of the nature of the evidence, particularly the uncertainty in the clinical and economic evaluations, it is difficult to distinguish between the different surgical procedures.

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KW - surgery

KW - review

KW - literature

KW - model

KW - economic

KW - VERTICAL BANDED GASTROPLASTY

KW - INTENTIONAL WEIGHT-LOSS

KW - QUALITY-OF-LIFE

KW - GASTRIC BYPASS

KW - RANDOMIZED TRIAL

KW - SUBJECTS SOS

KW - JEJUNOILEAL BYPASS

KW - SURGICAL-TREATMENT

KW - BLOOD-PRESSURE

KW - FOLLOW-UP

U2 - 10.1038/sj.ijo.0802394

DO - 10.1038/sj.ijo.0802394

M3 - Article

VL - 27

SP - 1167

EP - 1177

JO - International Journal of Obesity

JF - International Journal of Obesity

SN - 0307-0565

IS - 10

ER -