Cost-Effectiveness of Endoscopic Bariatric Therapies Compared with Laparoscopic Sleeve Gastrectomy and Semaglutide

INTRODUCTION: Endoscopic bariatric therapies, including endoscopic sleeve gastroplasty (ESG) and intragastric balloon (IGB), are emerging as less invasive alternatives to bariatric surgery. However, their economic value relative to established treatments such as bariatric surgery and pharmacotherapy remains uncertain. This study evaluated the cost-effectiveness of endoscopic bariatric therapies compared with surgery and semaglutide from a UK health system perspective. METHODS: Three state-transition Markov models compared: (1) ESG versus laparoscopic sleeve gastrectomy (LSG), (2) ESG versus semaglutide, and (3) IGB versus semaglutide. The models simulated transitions between body mass index (BMI)-defined health states over a 5-year time horizon using treatment effectiveness data derived from published studies and expert input. Outcomes were expressed as quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the UK National Health Service perspective. Deterministic and probabilistic sensitivity analyses explored uncertainty. RESULTS: For patients with class II-III obesity, LSG was cost-effective compared with ESG (£10,593/QALY). For class I and II obesity, ESG generated modestly greater QALYs than semaglutide at slightly higher cost (ICER £7,267/QALY). Semaglutide was dominant compared with IGB, producing greater health gains at lower cost. Results were most sensitive to intervention costs and assumptions regarding long-term recurrent weight gain. CONCLUSIONS: Endoscopic bariatric therapies may represent a cost-effective option for obesity management depending on patient characteristics and comparator treatments. LSG remains the most cost-effective intervention for severe obesity, whereas ESG may offer a cost-effective alternative to pharmacotherapy for patients with lower BMI.