Authors' objectives: Bariatric surgery can improve health outcomes but high-quality comparative evidence about different procedures is limited. To compare the effectiveness and cost-effectiveness of Roux-en-Y gastric bypass (Bypass), adjustable gastric banding (Band) and sleeve gastrectomy (Sleeve) for people living with severe obesity. People who are overweight or obese may benefit from surgery to lose weight (bariatric surgery), improve quality of life and health. While several operations are available, it is uncertain which procedure leads to the best results for patients and the National Health Service. To compare the clinical and cost-effectiveness of Bypass, Band and Sleeve for the treatment of severe and complex obesity. To develop a core outcome set for bariatric surgery.

Authors' results and conclusions: One thousand three hundred and fifty-one participants were randomised between December 2012 and September 2019. Five participants withdrew consent to use their data, leaving 1346 (462 Bypass, 464 Band, 420 Sleeve). The mean age was 47.3 years, 1020 (75.9%) were women and the mean weight and body mass index was 129.7 kg and 46.4 kg/m2, respectively. Overall, 1183 (87.5%) of participants underwent surgery within 3 years, with a median waiting time of 5 months (interquartile range 2.5–10.1 months). At least 50% excess weight loss at 3 years was achieved for 276/405 (68.1%) participants randomised to Bypass, 97/383 (25.3%) randomised to Band and 142/342 (41.5%) randomised to Sleeve [adjusted risk difference (Bypass–Band) + 40.7%, 98% confidence interval (+ 33.9% to + 47.5%); (Sleeve–Band) + 14.7% (+ 5.2% to + 24.2%), (Sleeve–Bypass) −26.0% (−35.8% to −16.3%)]. Mean EQ-5D scores at 3 years were 0.72 (standard deviation 0.29), 0.62 (0.33) and 0.68 (0.30) for participants randomised to Bypass, Band and Sleeve, respectively [adjusted mean difference (Bypass–Band) + 0.079 (+ 0.040 to + 0.117), (Sleeve–Band) + 0.045 (+ 0.006 to + 0.085), (Sleeve–Bypass) −0.033 (−0.072 to + 0.006)]. Secondary outcomes showed similar trends. The adverse event rate was highest in the Band group and lowest with Sleeve. Bypass was the most cost-effective procedure, with probabilities

Authors' methods: Multicentre, parallel-group, randomised controlled trial conducted in 12 National Health Service hospitals. Adults with a body mass index ≥ 35 kg/m2 with comorbidity or body mass index ≥ 40 kg/m2 without comorbidity were eligible. Participants were initially randomised 1 : 1 to Bypass or Band. After 32 months of recruitment, the trial was adapted to include Sleeve, and participants were randomised to Bypass, Band or Sleeve thereafter. Participants were followed up for 3 years. Bypass, Band and Sleeve surgery. Primary outcomes were self-reported quality of life (EQ-5D-5L utility score) and weight (at least 50% excess weight lost) at 3 years. Sleeve and Bypass were each considered superior to Band if there was non-inferior excess weight loss (

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hta/09/127/53

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hta/CXSE2951

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/CXSE2951

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