Premium
Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review
Author(s) -
Campbell J. A.,
Venn A.,
Neil A.,
Hensher M.,
Sharman M.,
Palmer A. J.
Publication year - 2016
Publication title -
obesity reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.845
H-Index - 162
eISSN - 1467-789X
pISSN - 1467-7881
DOI - 10.1111/obr.12424
Subject(s) - medicine , health care , productivity , indirect costs , economic evaluation , systematic review , medline , health economics , surgery , public health , nursing , business , economic growth , economics , accounting , pathology , political science , law
Summary 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/m 2 or long‐term waitlisted) for surgery. © 2016 World Obesity