Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Dwayne Boyers; Lise Retat; Elisabet Jacobsen; Alison Avenell; Paul Aveyard; Emily Corbould; Abbygail Jaccard; David Cooper; Clare Robertson; Magaly  Acevez-Martins; Benshuai Xu; Zoe Skea; Marijn de Bruin; REBALANCE team

doi:10.1038/s41366-021-00849-8

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Dwayne Boyers^* (Corresponding Author), Lise Retat, Elisabet Jacobsen, Alison Avenell, Paul Aveyard, Emily Corbould, Abbygail Jaccard, David Cooper, Clare Robertson, Magaly Acevez-Martins, Benshuai Xu, Zoe Skea, Marijn de Bruin, REBALANCE team

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

1 Downloads (Pure)

Abstract

OBJECTIVES: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.

METHODS: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.

RESULTS: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.

CONCLUSIONS: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

Original language	English
Pages (from-to)	2179-2190
Number of pages	12
Journal	International Journal of Obesity
Volume	45
Issue number	10
Early online date	4 Jun 2021
DOIs	https://doi.org/10.1038/s41366-021-00849-8
Publication status	Published - 31 Oct 2021

Keywords

Health policy
Lifestyle modification
Weight management

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1038/s41366-021-00849-8Licence: CC BY

Boyers_etal_IJO_Cost-Effectiveness_Of_VoR
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Final published version, 965 KBLicence: CC BY

Cite this

Boyers, D., Retat, L., Jacobsen, E., Avenell, A., Aveyard, P., Corbould, E., Jaccard, A., Cooper, D., Robertson, C., Acevez-Martins, M., Xu, B., Skea, Z., de Bruin, M., & REBALANCE team (2021). Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. International Journal of Obesity, 45(10), 2179-2190. https://doi.org/10.1038/s41366-021-00849-8

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity : a decision analysis model. / Boyers, Dwayne (Corresponding Author); Retat, Lise; Jacobsen, Elisabet et al.

In: International Journal of Obesity, Vol. 45, No. 10, 31.10.2021, p. 2179-2190.

Research output: Contribution to journal › Article › peer-review

Boyers, D, Retat, L, Jacobsen, E , Avenell, A, Aveyard, P, Corbould, E, Jaccard, A, Cooper, D , Robertson, C, Acevez-Martins, M, Xu, B, Skea, Z , de Bruin, M & REBALANCE team 2021, 'Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model', International Journal of Obesity, vol. 45, no. 10, pp. 2179-2190. https://doi.org/10.1038/s41366-021-00849-8

@article{5fde6abe74374cbf90e27198aa4525c6,

title = "Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model",

abstract = "OBJECTIVES: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.METHODS: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.RESULTS: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.CONCLUSIONS: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.",

keywords = "Health policy, Lifestyle modification, Weight management",

author = "Dwayne Boyers and Lise Retat and Elisabet Jacobsen and Alison Avenell and Paul Aveyard and Emily Corbould and Abbygail Jaccard and David Cooper and Clare Robertson and Magaly Acevez-Martins and Benshuai Xu and Zoe Skea and {de Bruin}, Marijn and {REBALANCE team}",

note = "Acknowledgements We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw, Su Sethi. +Current address HealthLumen, London. The REBALANCE team Elisabet Jacobsen1, Dwayne Boyers1, David Cooper3, Lise Retat2, Paul Aveyard4, Fiona Stewart3, Graeme MacLennan3, Laura Webber2, Emily Corbould2, Benshuai Xu2, Abbygail Jaccard2, Bonnie Boyle3, Eilidh Duncan3, Michal Shimonovich3, Cynthia Fraser3, Lara Kemp3, Clare Robertson3, Zo{\"e} Skea3, Marijn de Bruin6, Alison Avenell3 Funding The project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The Health Economics and Health Services Research Units at the University of Aberdeen are core funded by the Chief Scientists Office (CSO) of the Scottish Government Health and Social Care Directorate. Correction | Open Access | Published: 26 August 2021 Correction: Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. D. Boyers, L. Retat, E. Jacobsen, A. Avenell, P. Aveyard, E. Corbould, A. Jaccard, D. Cooper, C. Robertson, M. Aceves-Martins, B. Xu, Z. Skea, M. de Bruin & and the REBALANCE team. International Journal of Obesity (2021) The Original Article was published on 04 June 2021 Correction to: International Journal of Obesity https://doi.org/10.1038/s41366-021-00849-8 ",

year = "2021",

month = oct,

day = "31",

doi = "10.1038/s41366-021-00849-8",

language = "English",

volume = "45",

pages = "2179--2190",

journal = "International Journal of Obesity",

issn = "0307-0565",

publisher = "Nature Publishing Group",

number = "10",

}

TY - JOUR

T1 - Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity

T2 - a decision analysis model

AU - Boyers, Dwayne

AU - Retat, Lise

AU - Jacobsen, Elisabet

AU - Avenell, Alison

AU - Aveyard, Paul

AU - Corbould, Emily

AU - Jaccard, Abbygail

AU - Cooper, David

AU - Robertson, Clare

AU - Acevez-Martins, Magaly

AU - Xu, Benshuai

AU - Skea, Zoe

AU - de Bruin, Marijn

AU - REBALANCE team

N1 - Acknowledgements We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw, Su Sethi. +Current address HealthLumen, London. The REBALANCE team Elisabet Jacobsen1, Dwayne Boyers1, David Cooper3, Lise Retat2, Paul Aveyard4, Fiona Stewart3, Graeme MacLennan3, Laura Webber2, Emily Corbould2, Benshuai Xu2, Abbygail Jaccard2, Bonnie Boyle3, Eilidh Duncan3, Michal Shimonovich3, Cynthia Fraser3, Lara Kemp3, Clare Robertson3, Zoë Skea3, Marijn de Bruin6, Alison Avenell3 Funding The project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The Health Economics and Health Services Research Units at the University of Aberdeen are core funded by the Chief Scientists Office (CSO) of the Scottish Government Health and Social Care Directorate. Correction | Open Access | Published: 26 August 2021 Correction: Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. D. Boyers, L. Retat, E. Jacobsen, A. Avenell, P. Aveyard, E. Corbould, A. Jaccard, D. Cooper, C. Robertson, M. Aceves-Martins, B. Xu, Z. Skea, M. de Bruin & and the REBALANCE team. International Journal of Obesity (2021) The Original Article was published on 04 June 2021 Correction to: International Journal of Obesity https://doi.org/10.1038/s41366-021-00849-8

PY - 2021/10/31

Y1 - 2021/10/31

N2 - OBJECTIVES: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.METHODS: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.RESULTS: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.CONCLUSIONS: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

AB - OBJECTIVES: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.METHODS: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.RESULTS: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.CONCLUSIONS: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

KW - Health policy

KW - Lifestyle modification

KW - Weight management

UR - http://europepmc.org/abstract/med/34088970

UR - https://doi.org/10.1038/s41366-021-00931-1

UR - http://www.scopus.com/inward/record.url?scp=85107589884&partnerID=8YFLogxK

U2 - 10.1038/s41366-021-00849-8

DO - 10.1038/s41366-021-00849-8

M3 - Article

C2 - 34088970

VL - 45

SP - 2179

EP - 2190

JO - International Journal of Obesity

JF - International Journal of Obesity

SN - 0307-0565

IS - 10

ER -

Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this