Bariatric surgery : an HTA report on the efficacy, safety and cost-effectiveness

Louwagie P, Neyt M, Dossche D, Camberlin C, ten Geuzendam B, Van Den Heede K, Van Brabandt H
Record ID 32018000250
Authors' results and conclusions: • Obesity is a common condition that can lead to significant health problems. It is more and more often considered a chronic (often complex) disorder. • A change in lifestyle (nutrition and physical activity) remains the basic treatment due to its relatively low cost and non-invasive nature, and thus also the limited risks. • Metabolic and bariatric surgerya (MBS) is now reimbursed in Belgium for the indication of morbid obesity (BMI ≥40) or severe obesity (BMI ≥35) in combination with the following obesity-related disorders: severe, difficult-to-treat hypertension, type 2 diabetes or obstructive sleep apnoea syndrome (OSAS). Reimbursement is reserved for adults (≥18 years of age), after multidisciplinary consultation, if a diet for at least one year has had no lasting success. • The most common MBS procedures are the RYGB (Roux-en-Y Gastric Bypass) also called a “Bypass”, and the SG (Sleeve Gastrectomy) also called “gastric reduction”. The“gastric band” (LAGB – Laparoscopic Adjustable Gastric Banding) is seldom used due to less weight loss and longer-term complications. • On the basis of randomised studies, it appears that MBS leads to a significant and sustainable weight loss in the majority of those operated on. The physical components of the quality of life also improve. In patients with diabetes there is a higher rate of diabetes remission in comparison with non-surgical treatment, although the disorder occurs again in some patients after several years. Observational data indicate a drop in premature deaths due to disorders caused by obesity. • The decision to have MBS cannot be made lightly, because it does not solve all problems (e.g. psychological problems), and side effects such as vitamin and micronutrient deficiencies can occur. A large number of repeat procedures is also observed. • Although the list of possible side effects is long, the overall benefit-risk balance at thepopulation level is favourable. But candidates for MBS should be adequately informed of these risks, and of the necessity of a lifelong adjustment in lifestyle. • The economic evaluations of MBS for the currently reimbursed indications indicate a relatively low ICER (incremental cost-effectiveness ratio) or even cost savings. The current indications can thus be maintained. For two ‘new’ indications we establish the following: o For persons with type 2 diabetes and obesity with a BMI of 30 -
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Full HTA
Country: Belgium
MeSH Terms
  • Bariatric Surgery
  • Belgium
  • Obesity
  • Cost-Benefit Analysis
  • Bariatric Surgery
  • Technology Assessment Biomedical
Organisation Name: Belgian Health Care Knowledge Centre
Contact Address: Administrative Centre Botanique, Doorbuilding (10th floor), Boulevard du Jardin Botanique 55, B-1000 Brussels, Belgium tel: +32 2 287 33 88 fax: +32 2 287 33 85
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Copyright: Belgian Health Care Knowledge Centre (KCE)
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