S. Bairdain1, M. Samnaliev2 1Boston Children’s Hospital,Department Of Pediatric Surgery,Boston, MA, USA 2Boston Children’s Hospital,Harvard Medical School,Boston, MA, USA
Introduction: The current estimates of the prevalence adolescent morbid obesity and severe morbid obesity are 21% and 6.6%, respectively. Obesity, if left untreated, may result in a variety of comorbid conditions and earlier mortality. Adolescent bariatric surgery is expensive, but may be an effective means to ameliorate these conditions, and risk of earlier mortality. We aimed to develop a model that can be used to evaluate the long term cost-effectiveness of bariatric surgery.
Methods: All adolescents, who participated in our bariatric surgery multidisciplinary program from January 2010 to December of 2013 were included if they had at least 12 months follow-up following their surgery. A Markov cohort model was used to project costs, BMI and QALYs over a lifetime starting at age 18. Intervention costs included all operative as well as pre, and 12 month post-operative care costs. We estimated reductions in BMI after surgery and linked that information with the Medical Expenditures Panel Survey (MEPS) to estimate future savings from reduced medical care use. We used MEPS and other external data sources to estimate the association between BMI and health-related quality of life (HRQL). We linked BMI reductions with changes in life expectancy using publicly available data from the CDC. Incremental costs and quality-adjusted life years (QALYs) of surgery (vs. no surgery) were then estimated over different time periods.
Results: From January 2010 to December 2013, data from 11 patients were analyzed. Ninety percent (n=10) were female. Median age at surgery was 17 (1.3) years. Median preoperative body mass index (BMI) was 48.7 (6.6) kg/m2. All patients underwent a laparoscopic Roux-en-Y Gastric Bypass (RYGB) and 45% (n=5) had a concomitant hiatal hernia repair. Median length of stay was 3 days (range: 2-4 days). There were no complications. At 1 year follow-up, mean weight loss was 37.5 (13.5) kg and the corresponding BMI was 35.4(reduction of 13.2, p<0.01). Mean total intervention costs/person were $25,854 (sd=2,044). A unit change in BMI was associated with future medical care savings of $157 / year and with an increase in both quality of life and life expectancy. Bariatric surgery was not cost-effective in the first 3 years after surgery, but became cost-effective after that (e.g., $74,328/QALY in year 4 and 32,453/QALY and lower in year 7 and afterwards).
Conclusion: Our results suggest that bariatric surgery among adolescents may be cost-effective when evaluated over a long period of time (e.g. 4 years). Future studies on a large scale are needed to show a continued improvement in QALYS and to evaluate earlier cost-effectiveness of the procedure.