Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations

Karen Jordan (), Christopher G. Fawsitt, Paul G. Carty, Barbara Clyne, Conor Teljeur, Patricia Harrington and Mairin Ryan
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Karen Jordan: RCSI University of Medicine and Health Sciences
Christopher G. Fawsitt: Health Information and Quality Authority
Paul G. Carty: RCSI University of Medicine and Health Sciences
Barbara Clyne: Health Information and Quality Authority
Conor Teljeur: Health Information and Quality Authority
Patricia Harrington: Health Information and Quality Authority
Mairin Ryan: Health Information and Quality Authority

The European Journal of Health Economics, 2023, vol. 24, issue 4, No 7, 575-590

Abstract: Abstract Aim To systematically identify and appraise the international literature on the cost-effectiveness of metabolic surgery for the treatment of comorbid type 2 diabetes (T2D) and obesity. Methods A systematic search was conducted in electronic databases and grey literature sources up to 20 January 2021. Economic evaluations in a T2D population or a subpopulation with T2D were eligible for inclusion. Screening, data extraction, critical appraisal of methodological quality (Consensus Health Economic Criteria list) and assessment of transferability (International Society for Pharmacoeconomics and Outcomes Research questionnaire) were undertaken in duplicate. The incremental cost-effectiveness ratio (ICER) was the main outcome. Costs were reported in 2020 Irish Euro. Cost-effectiveness was interpreted using willingness-to-pay (WTP) thresholds of €20,000 and €45,000/quality-adjusted life year (QALY). Due to heterogeneity arising from various sources, a narrative synthesis was undertaken. Results Thirty studies across seventeen jurisdictions met the inclusion criteria; 16 specifically in a T2D population and 14 in a subpopulation with T2D. Overall, metabolic surgery was found to be cost-effective or cost-saving. Where undertaken, the results were robust to sensitivity and scenario analyses. Of the 30 studies included, 15 were considered high quality. Identified limitations included limited long-term follow-up data and uncertainty regarding the utility associated with T2D remission. Conclusion Published high-quality studies suggest metabolic surgery is a cost-effective or cost-saving intervention. As the prevalence of obesity and obesity-related diseases increases worldwide, significant investment and careful consideration of the resource requirements needed for metabolic surgery programmes will be necessary to ensure that service provision is adequate to meet demand.

Keywords: Diabetes; Metabolic surgery; Bariatric surgery; Systematic review; Cost-effectiveness; Economic evaluation (search for similar items in EconPapers)
JEL-codes: I1 I18 (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01494-2

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