rationale for bariatric surgery: medical & financial arguments

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Rationale for Bariatric Surgery:Medical & Financial Arguments

Abeezar I. Sarela MSc MS MD FRCSConsultant in Upper GI & Bariatric Surgery

Leeds Teaching Hospitals NHS Trust

Lecture at Derby Bariatric Surgery Course14-06-2012


Why should we be paid to do Bariatric Surgery?


Rationale for Bariatric Surgery

Medical 1. Efficacy

2. Efficiency

3. Safety

Financial


Medical Rationale For Bariatric Surgery


Weight Loss with Bariatric Surgery

Sjostrom L et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med 2007;357:741-52.


Bariatric Surgery: What is the Evidence that it Works?

• 22,094 patients• Excess weight loss– Bypass: 60-75%– Band: 55-65%

• Operative mortality– Bypass: 0.5%– Band: 0.1%

• Diabetes: Resolved in 77%• Hypertension: Resolved in 62%• Obstructive Sleep Apnea: Resolved in 86%

Bariatric Surgery. A Systematic Review and Meta-Analysis. JAMA 2004;292:1724-1737



• USA• 1984-2002• 7925 gastric bypass patients vs. 7925 weight

and risk matched controls• Significantly ↓ mortality in bypass patients– Overall mortality ↓ 40%– Coronary disease related mortality ↓ 56%– Diabetes related mortality ↓ 92%– Cancer related mortality ↓ 60%

Long-Term Mortality After Gastric Bypass SurgeryNEJM 2007;357:753-61



• 11 years follow-up• Bariatric surgery 2010 patients vs.

Conventional treatment 2037 patients• Weight loss– Bypass: 2 years, 32%; 10 years, 25%– Banding: 2 years, 20%; 10 years, 14%

• Risk adjusted hazard ratio for death: bariatric surgery vs. conventional treatment – 0.70

Effects of Bariatric Surgery on Mortality in Swedish Obese PatientsNEJM 2007;357:741-752


Effects of Bariatric Surgery on Type 2 DM A Systematic Review and Meta-analysis

• 621 studies: 1990-2006

• 135, 246 patients

• Women: 80%

• Mean BMI 48 kg/m2

• Resolution of T2DM : 78%

• Resolution or improvement: 84%Buchwald et al. Am J Med 2009;122:248-256


LexingtonStick or carrot?When it comes to obesity, Michelle Obama can teach Michael Bloomberg somethingJun 9th 2012 | from the print edition


Health Economics Treating Obesity with Bariatric Surgery


NIHR HTA

Southampton Health Technology Assessments Centre, University of Southampton, UK.

Health Technology Assessment Program was established in 1993 as part of the National Institute for Health Research.

Research findings of HTA directly influence decision-making bodies such as NICE and DoH.


NIHR HTA of Bariatric Surgery

• Bariatric surgery was cost-effective in comparison to non-surgical treatment in the published estimates.

• Estimates are unlikely to be reliable and not generalizable because of methodological shortcoming and modeling assumptions.


NIHR HTA of Bariatric Surgery

• Development of a new economic model

• Surgical management was more costly than non-surgical management but gave improved outcomes.

• Incremental cost-effectiveness ratios of £2000-£4000 per QALY gained – within the cost-effectiveness range for NHS decision-making.


Office of Health

Economics


Shedding The Pounds


Conclusion

• Bariatric Surgery is clinically effective and cost-effective as compared to non-surgical interventions.

• Uncertainties:– QOL– Impact of surgeon experience– Late complications leading to re-operation– Duration of co-morbidity remission– Potential benefits of early intervention

rationale for bariatric surgery: medical & financial arguments

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