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Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation

International Journal of Obesity volume 27, pages 1167–1177 (2003)Cite this article

Abstract

OBJECTIVE: To assess the clinical and cost effectiveness of surgery for people with morbid obesity.

DESIGN: A systematic review of randomised control trials (RCTs), prospective clinical trials and economic evaluations identified from 14 electronic databases (including Medline, Cochrane library and Embase from their inception to October 2001), bibliographies and consultation with experts and manufacturers was performed to assess the clinical and cost effectiveness of different surgical procedures and nonsurgical management for morbid obesity. An economic evaluation was undertaken to assess cost effectiveness in the UK.

SUBJECTS: People diagnosed as morbidly obese, defined as a body mass index (BMI) (weight in kilograms/height in metres2) >40 kg/m2, or with a BMI>35 kg/m2 with serious comorbid disease, in whom previous nonsurgical interventions had failed.

MEASUREMENTS: The outcomes assessed included weight change, quality of life, peri- and postoperative morbidity and mortality, revision rates and obesity comorbidities. Cost effectiveness was modelled from these data and presented as cost per quality-adjusted life year (QALY).

RESULTS: Included studies differed in methodological quality. Surgery resulted in a significantly greater loss of weight (23–37 kg more weight) than nonsurgical treatment, which was maintained to 8 years and led to improvements in quality of life and comorbidities. The economic evaluation of surgery compared with nonsurgical management suggested that surgery was cost effective at £11 000 per QALY. Comparisons of the different types of surgery were equivocal.

CONCLUSION: Surgery for morbid obesity appears to be clinically and cost effective. Because of the nature of the evidence, particularly the uncertainty in the clinical and economic evaluations, it is difficult to distinguish between the different surgical procedures.

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Acknowledgements

We thank the advisory group for advice and peer review of the research protocol and/or a draft of the original report for NICE, including Professor JN Baxter, Professor of Surgery, University of Wales; Sir Alfred Cuschieri, Professor of Surgery, University of Dundee; Professor Philip James, Chairman, International Obesity Task Force; Professor Roland Jung, Chief Scientist to Scottish Executive, Dundee; Dr AM Mir, Consultant Physician and Senior Lecturer, University of Wales College of Medicine, Cardiff; Mr JDB Miller, Consultant Surgeon, Dr Gray's Hospital, Elgin; Dr Ian Campbell, NOF Chairman, Nottingham; Dr JPH Wilding, Reader in Medicine, University Hospital Aintree, Liverpool; Mr Peter Sedman, Consultant Surgeon, Hull Royal Infirmary; Ms Mary O’Kane, Chief Dietitian, The General Infirmary, Leeds; Professor Bruce Campbell, Consultant General Surgeon, Royal Devon & Exeter Hospital, Exeter. We thank Ms Liz Hodson for support with obtaining information; Dr Norman Waugh and Dr Emma Loveman, SHTAC, University of Southampton; Dr Alison Avenell, University of Aberdeen Medical School, Aberdeen; Mr David Carson, Head of Financial Performance Management, Tayside Health Board, Dundee; Dr Janis Baird, Specialist Registrar in Public Health Medicine, University of Southampton. This work was funded by the NHS R&D HTA Programme. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NHS Executive.

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  1. Southampton Health Technology Assessments Centre (SHTAC), Wessex Institute for Health Research and Development, University of Southampton, Southampton, UK

    A Clegg, J Colquitt, M Sidhu & P Royle

  2. Robertson Centre for Biostatistics, University of Glasgow Level 11 Boyd Orr Building, University Avenue, Glasgow, UK

    A Walker

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Correspondence to A Clegg.

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Clegg, A., Colquitt, J., Sidhu, M. et al. Clinical and cost effectiveness of surgery for morbid obesity: a systematic review and economic evaluation. Int J Obes 27, 1167–1177 (2003). https://doi.org/10.1038/sj.ijo.0802394

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