What Are the Real Procedural Costs of Bariatric Surgery? A Systematic Literature Review of Published Cost Analyses

Brett Doble, Sarah Wordsworth, Chris A Rogers, Richard Welbourn, James Byrne, Jane M Blazeby, By-Band-Sleeve Trial Management Group, Jane Blazeby, Richard Welbourn, James Byrne, Barnaby C Reeves, Sarah Wordsworth, Robert C Andrews, Janice L Thompson, Graziella Mazza, Chris A Rogers, Brett Doble, Sarah Wordsworth, Chris A Rogers, Richard Welbourn, James Byrne, Jane M Blazeby, By-Band-Sleeve Trial Management Group, Jane Blazeby, Richard Welbourn, James Byrne, Barnaby C Reeves, Sarah Wordsworth, Robert C Andrews, Janice L Thompson, Graziella Mazza, Chris A Rogers

Abstract

This review aims to evaluate the current literature on the procedural costs of bariatric surgery for the treatment of severe obesity. Using a published framework for the conduct of micro-costing studies for surgical interventions, existing cost estimates from the literature are assessed for their accuracy, reliability and comprehensiveness based on their consideration of seven 'important' cost components. MEDLINE, PubMed, key journals and reference lists of included studies were searched up to January 2017. Eligible studies had to report per-case, total procedural costs for any type of bariatric surgery broken down into two or more individual cost components. A total of 998 citations were screened, of which 13 studies were included for analysis. Included studies were mainly conducted from a US hospital perspective, assessed either gastric bypass or adjustable gastric banding procedures and considered a range of different cost components. The mean total procedural costs for all included studies was US$14,389 (range, US$7423 to US$33,541). No study considered all of the recommended 'important' cost components and estimation methods were poorly reported. The accuracy, reliability and comprehensiveness of the existing cost estimates are, therefore, questionable. There is a need for a comparative cost analysis of the different approaches to bariatric surgery, with the most appropriate costing approach identified to be micro-costing methods. Such an analysis will not only be useful in estimating the relative cost-effectiveness of different surgeries but will also ensure appropriate reimbursement and budgeting by healthcare payers to ensure barriers to access this effective treatment by severely obese patients are minimised.

Keywords: Adjustable gastric banding; Bottom-up costing; Costs; Gastric bypass; Gross costing; Micro-costing; Obesity; Sleeve gastrectomy; Top-down costing.

Conflict of interest statement

Conflict of Interest

R.W. declares receiving support from Ethicon Endo-Surgery for attending conferences and funding a Bariatric Clinical Fellow at their hospital as well as receiving honoraria from Novo Nordisk.

The other authors declare that they have no conflict of interest, except support from a government grant as detailed in the acknowledgements.

Ethical Approval

For this study, formal consent is not required, as it is a review of the literature.

Informed Consent

Does not apply.

Figures

Fig. 1
Fig. 1
Flow diagram for selection of studies

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