Mixed
Roux-en-Y gastric bypass (RYGB) surgery is the most cost-effective intervention for adults with severe obesity (BMI ≥ 35 kg/m2) compared to non-surgical weight management programs, primarily due to superior long-term weight loss and reduced incidence of obesity-related diseases.
For individuals with severe obesity (BMI ≥ 35), bariatric surgery (specifically RYGB) offers the best long-term health and economic value compared to diet and lifestyle programs alone. While surgery has high upfront costs and requires lifelong medical follow-up, it significantly reduces the risk of serious diseases like diabetes and heart disease, leading to more quality-adjusted life years. If surgery is not an option, a standard 12-week behavioral weight management program is the next most cost-effective choice, but adding very low-calorie diets to standard programs is not cost-effective.
RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains... RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources.
Why this rating
Based on a decision analysis model using data from RCTs and long-term observational studies (SOS, Look AHEAD), but limited by assumptions about weight regain and lack of probabilistic sensitivity analysis.
Source
Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model
Dwayne Boyers et al. · International Journal of Obesity · 2021
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