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Presentation

Session: Dealing with Obesity
Room: Ball Room
Time: Thu 16:00-17:15

Presenter: Suvi Mäklin (National Institute for Health and Welfare. Finohta)

Abstract

Introduction

The number of bariatric surgical operations is low in Finland, but the demand is increasing rapidly. About 400 bariatric operations were carried out in Finland in 2008 while the corresponding figure in Sweden was 3000.

Objectives

To evaluate the cost-utility of bariatric surgery (gastric bypass, sleeve gastrectomy and gastric banding) versus ordinary treatment in health care.

Methods

Analysis was done from health care providers' perspective using a Markov cycle tree and a time horizon of ten years. Events during the first year, including mortality and primary complications resulting in reoperation, were modelled in a decision tree. Then the patient cohort moves into a state transition model including four states: alive (no reoperation or abdominoplasty), reoperation, abdominoplasty, and death. The parameter values were taken from a large representative population survey measuring health-related quality of life (HRQoL) and health service use, as well as from registers and literature. When necessary, expert opinions were used. Different types of sensitivity analysis were conducted.

Results

In CUA bariatric surgery dominated strongly the ordinary treatment. The mean cost was 31 800 € and 44 800 € and the mean number of QALYs 7.05 and 6.51 for bariatric surgery and ordinary treatment, respectively. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses and the results were robust.

Discussion

The model takes into account all the major events. Strengths of the model include the actual cost data on bariatric surgery and inclusion of abdominoplasty, which seems to be neglected in previous analyses. Also, a unique set of data on mean health care costs and HRQoL for both alternatives was available. The time horizon is rather short and may underestimate the effectiveness of bariatric surgery, but it is based on available follow-up data.

Key Terms

Bariatric surgery, health technology assessment, cost-effectiveness, cost-utility

Authors:

Suvi Mäklin (National Institute for Health and Welfare. Finohta) , Antti Malmivaara (National Institute for Health and Welfare. CHESS) , Mikael Victorzon (Vaasa Central Hospital) , Vesa Koivukangas (Oulu University Hospital) , Miika Linna (National Institute for Health and Welfare. CHESS) and Harri Sintonen (National Institute for Health and Welfare AND University of Helsinki)

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