A prospective cost-effectiveness analysis of vertical banded gastroplasty for the treatment of morbid obesity.

Department of Surgery, University Hospital Maastricht, The Netherlands. wg.gemert@wxs.nlBACKGROUND: Surgical treatment of morbid obesity is gaining in popularity, because conservative treatment is ineffective. However, a cost-effectiveness analysis has never been performed and is the main goal of the present study. METHODS: 21 consecutive morbidly obese patients were tested before and after vertical banded gastroplasty (VBG). Quality of life was assessed with the Nottingham Health Profile and a visual analogue scale. A prevalence-based cost-of-illness analysis of morbid obesity was performed and the cost-effectiveness of VBG assessed. RESULTS: VBG resulted in a significant weight loss and an improved quality of life. The improved quality of life combined with 3.6 life-years gained after VBG resulted in 12 quality adjusted life-years (QALY) gained in a lifelong scenario. Lifelong costs of illness of morbidly obese persons ranged from $8,304 to $9,367. Total direct costs of VBG were $5,865. The percentage of patients performing paid labor increased from 19% before VBG to 48% after VBG, resulting in an average productivity gain of $2,765 per year. In summary, the cost-effectiveness analysis revealed that surgical treatment of morbid obesity by means of VBG saves $4,004 to $3,928 per QALY (overall dominance). CONCLUSION: Because treatment of morbid obesity with VBG results in QALYs gained and less costs, there is no doubt that this procedure should be introduced or continued from a societal point of view