Bariatric surgery cost-effective in teens, but only after five years

Last Updated: 2016-11-02

By Marilynn Larkin

NEW YORK (Reuters Health) - Bariatric surgery can be a cost-effective treatment for severely obese teens "if assessed over a time horizon of five years," Boston-based researchers suggest.

"Bariatric surgery is increasingly being considered as an option for adolescents who have not achieved adequate weight loss through nonsurgical therapy," Dr. Chin Hur and Matthew Klebanoff of Massachusetts General Hospital and colleagues write in JAMA Surgery, online October 26.

They note that in 242 adolescents in The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, total body weight decreased by 27%, on average, at three years after either Roux-en-Y gastric bypass (70.6%) or sleeve gastrectomy (29.4%).

Using data on 228 patients from Teen-LABS, Dr. Hur and Klebanoff developed a mathematical model to determine the cost-effectiveness of such surgery in severely obese adolescents. Patients' mean age was 17; mean body mass index was 53.

For the no surgery assessment, patients stayed at their initial BMI over time. For the surgery assessment, patients were at risk of initial morbidity, perioperative mortality and complications; however, they also benefited from quality-of-life improvements associated with weight loss over the longer term.

The main outcome measures were quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015 values), and incremental cost-effectiveness ratios (ICERs).

A willingness-to-pay threshold of $100,000 per QALY was used to determine cost effectiveness.

After three years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $30,747, resulting in an unfavorable ICER of $154,684 per QALY.

When the study results were extrapolated to four years, the ICER decreased to $114,078 per QALY.

Surgery became cost-effective by five years, with an ICER of $91,032 per QALY.

Dr. Hur and Klebanoff told Reuters Health, "It is important to keep in mind that the patients analyzed were adolescents who were severely obese (BMI=53: mean height=5 ft 6 inches and mean weight=328 lbs) and who had already failed lifestyle interventions such as recommendations for dieting and exercise."

"For the majority of adolescents, the initial approach should be dieting and exercise," they said by email. "Public health interventions focus on preventions such as taxes on sugar-sweetened beverages, calorie labeling on restaurant menus, and nutrition standards for food in schools."

"However, for the relatively small number of patients who are appropriate candidates, bariatric surgery can result in life-altering weight loss, which not only leads to the resolution and prevention of disease, but also allows adolescent patients to avoid the stigma, bullying, and isolation that often accompany severe obesity," they observed.

They added, "As evidence supporting the safety and efficacy of bariatric surgery continues to accrue for the adolescent population, it will likely become a more accepted and commonly utilized therapeutic option."

"Going forward," Dr. Hur and Klebanoff concluded, "we need longer-term studies that assess the impact of surgery on: weight loss . . . other chronic diseases such as diabetes and heart disease; on patients' psychological health and quality of life; and finally, on healthcare utilization."

Dr. William Adamson of the University of North Carolina School of Medicine in Chapel Hill, author of an accompanying editorial, told Reuters Health, "All of us, from patients to third-party payors to providers, resonate with the message delivered by this article, which shows that bariatric surgery in adolescents is not only safe and effective, but also cost-effective."

"The Teen Longitudinal Assessment of Bariatric Surgery cited in this article prospectively recognizes that a multifaceted approach, rather than just surgery alone, would be required to create and maintain successful weight loss in these patients," he said by email. "Each institution involved in the study followed the same multidisciplinary approach."

He added, "Not all obese teens are appropriate candidates for surgery. What Teen LABS tells us is that when the right patients are chosen for surgery and carefully treated through a multidisciplinary surgical protocol, effective weight loss that is safe, durable - and now, cost-effective - can be achieved."

Dr. Adamson concluded, "Physicians need to be more proactive in discussing, and even compassionately confronting, the problem of obesity with their patients and families. Only in this context can effective help, both medical and surgical, be pursued for our obese adolescents."

SOURCE: http://bit.ly/2fvFnwz and http://bit.ly/2fcXEed

JAMA Surg 2016.