Authors' objectives:

To systematically review the clinical effectiveness and cost-effectiveness of surgery for the management of morbid obesity and to develop a cost-effectiveness model using the best available evidence to determine cost-effectiveness in a UK setting.

Authors' results and conclusions: When compared with conventional treatment, surgery resulted in a significantly greater loss of weight (23-37 kg more weight), which was maintained at 8 years. As a consequence, there were improvements in QoL and co-morbidities associated with the loss of weight from surgery. Comparison of the different types of surgery showed that gastric bypass appeared more beneficial, with a greater weight loss (6-14 kg more weight) and/or improvements in co-morbidities and complications than either gastroplasty or jejunoileal bypass. Assessment of open versus laparoscopic gastric bypass and adjustable silicone gastric banding showed fewer serious complications with laparoscopic placement. Laparoscopic surgery had a longer operative time compared with open surgery, but resulted in reduced blood loss, proportion of patients requiring intensiv care unit stay, length of hospital stay, days to return to activities of daily living and days to return to work.

Authors' recommendations: Currently, limited numbers of morbidly obese people receive surgery in England and Wales. A constraint upon the development of any service would need to ensure there are adequately trained multi-disciplinary teams to operate and provide long-term support to patients. Given the proportions of patients who may benefit from surgery and the need for experienced teams with appropriate facilities, it would seem appropriate that any service should be provided within specialist facilities. If implemented, the additional total cost to the NHS in England and Wales may be 136.5 million GBP over the 20-year life-expectancies of the 50,000 patients who are thought to be morbidly obese and who may meet the criteria for surgery. The impact on the annual budget of the NHS is difficult to assess given the limited information on the incidence of morbid obesity. Expert opinion suggests that some 800 morbidly obese people may meet the criteria for surgery each year at an additional total cost of 2.2 million GBP over their 20-year life-expectancies. Any savings would depend on the non-financial constraints of any increase in surgery over the next few years, such as staffing, as well as the number of patients choosing to have surgery and the future costs of surgery that may change as the service develops.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.hta.ac.uk/1245

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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