Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model

Dwayne Boyers* (Corresponding Author), Lise Retat, Elisabet Jacobsen, Alison Avenell, Paul Aveyard, Emily Corbould, Abbygail Jaccard, David Cooper, Clare Robertson, Magaly Acevez-Martins, Benshuai Xu, Zoe Skea, Marijn de Bruin, REBALANCE team

*Corresponding author for this work

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OBJECTIVES: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m2), who are more at risk of obesity related diseases.

METHODS: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results.

RESULTS: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption.

CONCLUSIONS: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention.

Original languageEnglish
Pages (from-to)2179-2190
Number of pages12
JournalInternational Journal of Obesity
Issue number10
Early online date4 Jun 2021
Publication statusPublished - 31 Oct 2021

Bibliographical note

We thank the REBALANCE Advisory Group for all their advice and support during this project: Margaret Watson, Lorna Van Lierop, Richard Clarke, Jennifer Logue, Laura Stewart, Richard Welbourn, Jamie Blackshaw, Su Sethi. +Current address HealthLumen, London.

Elisabet Jacobsen1, Dwayne Boyers1, David Cooper3, Lise Retat2, Paul Aveyard4, Fiona Stewart3, Graeme MacLennan3, Laura Webber2, Emily Corbould2, Benshuai Xu2, Abbygail Jaccard2, Bonnie Boyle3, Eilidh Duncan3, Michal Shimonovich3, Cynthia Fraser3, Lara Kemp3, Clare Robertson3, Zoë Skea3, Marijn de Bruin6, Alison Avenell3

The project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04). See the HTA Programme website for further project information. The Health Economics and Health Services Research Units at the University of Aberdeen are core funded by the Chief Scientists Office (CSO) of the Scottish Government Health and Social Care Directorate.

Correction | Open Access | Published: 26 August 2021
Correction: Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: a decision analysis model. D. Boyers, L. Retat, E. Jacobsen, A. Avenell, P. Aveyard, E. Corbould, A. Jaccard, D. Cooper, C. Robertson, M. Aceves-Martins, B. Xu, Z. Skea, M. de Bruin & and the REBALANCE team. International Journal of Obesity (2021)
The Original Article was published on 04 June 2021 Correction to: International Journal of Obesity


  • Health policy
  • Lifestyle modification
  • Weight management


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