This study aimed to evaluate the cost-effectiveness of bariatric surgery (BS) compared to non-surgical treatment (NST) in Korean people with morbid obesity according to comorbidities and body mass index (BMI) severity.
The target cohort was people with morbid obesity, defined as BMI of ≥ 35 kg/m2, or obese people with BMI of 30–34.9 kg/m2 having obesity-related comorbidities. A decision-tree model for 1-year obesity treatment and Markov model for the rest of life were used. In the decision-tree model, the comorbidity remission rate and BMI change after 1-year treatment were decided based on a prospective clinical trial. In the Markov model, the transition probabilities were calculated considering the BMI level and age. The starting age of 20 years, a cycle length of 1 year, a time horizon of 80 years, and a 5% discount rate were applied for the base case from the healthcare system perspective.
In the base case, BS improved quality-adjusted life years (QALYs) and was the cost-effective option in total cohort (incremental cost-effectiveness ratio of BS vs. NST was 674 USD/QALY). It was shown to be cost-effective in all subgroup analyses based on BMI level. In particular, BS was a dominant alternative for the subgroup with basal BMI of 35.0–37.4 kg/m2. Various sensitivity analyses showed the robustness of results indicating the cost-effectiveness of BS.
BS at BMI of > 30 kg/m2 was more effective than NST for a reduction in BMI and remission of obesity-related comorbidities and was cost-effective in Korea.
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We thank the Health Insurance Review and Assessment Service (HIRA-NPS) for providing data for this study.
This study was funded by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number HC15C1322) and the Korea National Research Foundation (grant number NRF-2018R1D1A3B07047356).
Conflict of Interest
The authors declare that they have no conflict of interest.
The study was approved by the IRB of the Kyungpook National University (KNU 2016–0007). In addition, prospective clinical trials for the source data in this study were approved by the Institutional Review Board (IRB) of their respective centers (the approval number of IRB at principal investigator center: INHAUH 2016-06-015).
The NHIS-HEALS database was retrospectively established in an anonymous format, and the informed consent requirement for this study was waived, and informed consent was obtained from all individual participants included in the prospective clinical trial used for source data in this study.
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An, S., Park, H., Oh, S. et al. Cost-effectiveness of Bariatric Surgery for People with Morbid Obesity in South Korea. OBES SURG 30, 256–266 (2020). https://doi.org/10.1007/s11695-019-04122-w
- Cost-utility analysis
- Morbid obesity
- Bariatric surgery