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Bariatric surgery for teenagers cost-effective at 5 years
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Bariatric surgery in adolescents with severe obesity initially results in substantial economic costs and morbidity, but after 5 years it may be cost-effective, study data show.
Chin Hur, MD, MPH, of the Institute for Technology Assessment at Massachusetts General Hospital in Boston, and colleagues evaluated data from the Teen-Longitudinal Assessment of Bariatric Surgery study on 228 adolescents (mean age, 17 years; 75% girls) with severe obesity (mean BMI, 53 kg/m2) to determine the cost-effectiveness of bariatric surgery and no surgery. Quality-adjusted life-years (QALYs), total costs and incremental cost-effectiveness ratios were assessed at 3, 4 and 5 years after surgery.
After 3 years, the no-surgery group accumulated 2.057 QALYs, and the bariatric-surgery group accumulated 2.256; surgery cost $30,747 more than no surgery after 3 years. When a willingness-to-pay threshold was set at $100,000 per QALY for 3 years, bariatric surgery was not cost-effective. The incremental cost-effectiveness ratio was $114,078 per QALY at 4 years and decreased to $91,032 per QALY at 5 years.
“From an individual-patient perspective, though, bariatric surgery can result in life-altering weight loss, which not only leads to the resolution and prevention of disease, but also allows patients to avoid the stigma, bullying and isolation that often accompany severe obesity,” the researchers wrote. “As evidence supporting the safety and efficacy of bariatric surgery continues to accrue for the adolescent population, it will likely become a more accepted and commonly used therapeutic option. Our analysis indicates that it can also be cost-effective when assessed over a relatively short time horizon. Longer-term studies that track quality of life, weight loss, comorbidity resolution and health care costs are needed to confirm our findings.”
In an accompanying editorial, William T. Adamson, MD, of the division of pediatric surgery, department of surgery, University of North Carolina School of Medicine in Chapel Hill, wrote, “To be effective with children with obesity, both surgical and medical health care professionals must address their own general discomfort of discussing obesity with patients.
“As medical and surgical professionals, we must more aggressively shepherd our patients into comprehensive obesity prevention and treatment programs that show promise, including bariatric surgery,” Adamson said. – by Amber Cox
Disclosure: The researchers and Adamson report no relevant financial disclosures.
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