Obesity Surgery

, Volume 19, Issue 11, pp 1542–1549 | Cite as

Cost-effectiveness and Budget Impact of Obesity Surgery in Patients with Type 2 Diabetes in Three European Countries(II)

  • Marco Anselmino
  • Tanja Bammer
  • José Maria Fernández Cebrián
  • Frederic DaoudEmail author
  • Giuliano Romagnoli
  • Antonio Torres



This study aimed to establish a payer-perspective cost-effectiveness and budget impact model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs. conventional treatment (CT) in patients with a body mass index (BMI) ≥ 35 kg.m−2 and type 2 diabetes mellitus (T2DM) in Austria, Italy, and Spain.


A health economics model described in a previous publication was applied to resource utilization and cost data in AGB, GBP, and CT from Austria, Italy, and Spain in 2009.


The base case time scope is 5 years; the annual discount rate for utilities and costs is 3.5%. In Austria and Italy, both AGB and GBP are cost-saving and are thus dominant in terms of incremental cost-effectiveness ratio compared to CT. In Spain, AGB and GBP yield a moderate cost increase but are cost-effective, assuming a willingness-to-pay threshold of 30,000 euro per quality adjusted life-year. Under worst-case analysis, AGB and GBP remain cost-saving or around breakeven in Austria and Italy and remain cost-effective in Spain.


In patients with T2DM and BMI ≥ 35 kg.m−2 at 5-year follow-up vs. CT, AGB and GBP are not only clinically effective and safe but represent satisfactory value for money from a payer perspective in Austria, Italy, and Spain.


Obesity surgery Gastric bypass Adjustable gastric banding Cost-effectiveness Budget impact EQ-5D utility Diabetes 



Adjustable gastric banding


Budget impact


Conventional treatment


Diagnostic-related group


EuroQol three-level five-dimensional


Gastric bypass


Health technology assessment


Leistungsorientierte Krankenanstaltenfinanzierung: the point-based Austrian service-based hospital funding


Incremental cost-effectiveness ratio


Quality adjusted life-years


Type 2 diabetes mellitus


Willingness to pay: the maximum ICER accepted by health care payers



Financial support by Ethicon Endo-Surgery for Excel model software development and for resource utilization collection by clinicians is acknowledge.

Conflict of Interest Statements

Dr. Marco Anselmino: Ethicon Endo-Surgery Consultant for Bariatric Surgery

Dr Tanja Bammer: none

Dr José Maria Fernández Cebrián: none

Dr Frederic Daoud: Consultant in clinical epidemiology to Ethicon Endo-Surgery

Dr Giuliano Romagnoli: none

Pr Antonio Torres: none


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Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Marco Anselmino
    • 1
  • Tanja Bammer
    • 2
  • José Maria Fernández Cebrián
    • 3
  • Frederic Daoud
    • 4
    Email author
  • Giuliano Romagnoli
    • 5
  • Antonio Torres
    • 6
  1. 1.Bariatric Surgery UnitAzienda Ospedaliera PisanaPisaItaly
  2. 2.Surgery Unit BKH KufsteinKufsteinAustria
  3. 3.Fundación Hospital AlcorcónAlcorcónSpain
  4. 4.Medextens Clinical Epidemiology Dept.ParisFrance
  5. 5.U.O. di Chirurgia Ospedale Civile di Legnano, P.O, di MagentaMagentaItaly
  6. 6.Complutense University of Madrid Hospital Clinico San CarlosMadridSpain

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