Cost-effectiveness analysis of bariatric surgery in obese patients

ratio Objective. To perform cost-effectiveness analysis of bariatric surgery in adult obese patients compared to standard drug therapy; to analyze the impact of bariatric surgery on national budget system from the perspective of the healthcare system and the state. Material and methods. The mathematical model assessed clinical and economic effectiveness of two treatment methods: bariatric surgery vs. standard drug therapy in obese adult patients with BMI ≥40 kg/m2 regardless of comorbidities and obese adults with BMI ≥35 kg/m2 and comorbidities (diabetes mellitus type 2, joint diseases, obstructive sleep apnea syndrome). The model was used to predict all-cause mortality. Direct costs of treating obesity, other direct and indirect costs following losses in gross domestic product due to mortality of working-age population, as well as total costs and break-even point, incremental cost-effectiveness ratio (ICER) were calculated. The budget impact of bariatric surgery was analyzed. Results. We found higher cost and clinical efficacy of bariatric surgery compared to standard drug therapy for obesity. After bariatric surgery, mortality was lower by 20.65% in the first year and 45.69% in the seventh year compared to standard drug therapy. Bariatric surgery is characterized by higher costs related to surgical intervention. The last ones occurred at the beginning of modeling. Cost of therapy increased over time and spread over the entire modeling horizon. The cost per case of bariatric surgery was 303.574.00 rubles, standard drug therapy for obesity — 73.006.13 rubles per year, and these values increased over time. In turn, the total costs, including the costs of treating obesity, other direct costs, as well as indirect costs were significantly lower in the bariatric surgery group. In long-term period, this significantly reduced economic burden of the state on the treatment of morbid obesity by 30.84% and 63.12% without discounting over a 5-year and 7-year horizon, respectively. Taking into account obesity treatment cost, other direct and indirect costs, we achieved break-even point at the 86th, 56th and 45th month of modeling, respectively. Conclusion. Bariatric surgery in patients with morbid obesity can reduce the number of deaths. Additional one-time direct costs will be compensated over time due to higher cumulative cost of drug therapy, other direct and indirect costs for patients receiving drug therapy with possible break-even point after 45—86 months.