Kosteneffectiviteit van bariatrische chirurgie: Een review van economische evaluaties

Synopsis Bariatric surgery appears to be a cost-effective intervention for moderately to severely obese people compared to single lifestyle interventions. This appears from a review of the literature on cost-effectiveness of bariatric surgery. Almost all studies included lifestyle advice before and after the surgery. Surgery for morbid obesity led to weight loss, which reduced the risk of complications and hence resulted in a gain of quality adjusted life years and lower healthcare costs. In groups of patients with high obesity-related healthcare costs, like patients with type 2 diabetes, the use of bariatric surgery may save money within a relatively short period of time. The RIVM has provided a review of studies on the cost-effectiveness of bariatric surgery published between 2006 and 2012. The lack of clear definitions of lifestyle advices applied to patients in the intervention and control group in many studies hampered a full comparison of selected interventions in this review. Most studies were based on at most 12 months follow-up and assumed weight loss to remain constant after this period. Moreover, information on longterm complications was lacking. Future cost-utility studies should include long-term data on resource use, sustainability of the reduction in Body Mass Index, and incidence of late complications of bariatric surgery. Also they should take a societal perspective when relevant and include productivity losses. Finally it seems essential to include the additional lifestyle advice provided in the studies also in daily practice, since otherwise it is quite probable that cost-effectiveness in reality will be less favourable than found in the literature. Obesity and its co-morbidities are a major public health and economic concern. In the Netherlands, surgery has been used increasingly in the treatment of morbid obesity, during the past 20 years. The aim of the current review was to evaluate the cost-utility of bariatric surgery using different techniques (e.g. gastric bypass and gastric banding) compared to care as usual