Cost Eff Bariatric Surgery Webinar-Dr Reno

Cost Effectiveness of
Bariatric Surgery
Reno Rudiman
Perhimpunan Dokter Spesialis Bedah Digestif Indonesia

Introduction
Bariatric surgery is a well-documented treatment for

obesity
But uncertainties about the degree to which such surgery

is associated with health care cost reductions that are
sustained over time.
Background
In 2008, approximately 1.4 billion adults were considered

overweight worldwide
Of the 1.4 billion adults, approximately 300 million women

and > 200 million men were estimated to be obese.
Twelve million adults in the USA are considered morbidly

obese with body mass index (BMI) ≥ 40 kg/m2

Obesity in Indonesia
Riset Kesehatan Dasar (Riskedas) 2018:

Obesity prevalence in age over 18 is 21.8%
North Sulawesi 30.2%
DKI Jakarta 29.8%
East Kalimantan 28.7%
A signi cant increase from 2007 (10.7%) & 2013 (11.5%)

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Obesity Associated Problems
Obesity is associated with several comorbidities that increase

mortality rates
It is associated with hypertension, coronary artery disease,

dyslipidemia, metabolic liver disease, renal and urological
diseases, sleep apnea, diabetes, osteoarthritis, psychiatric
comorbidity, gastroesophageal re ux disease (GERD), and
various cancers

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Bariatric Surgery
Behavioral therapy, diet, and weight reduction medications have been

shown to be ineffective on morbidly obese patients
Since 2003, the use of surgery to treat morbid obesity has increased
Bariatric surgery is considered as a treatment option for class III (BMI

≥ 40 kg/m2) or class II (BMI 35.0–39.9 kg/m2) obesity with obesity-
related comorbidities that have previously not been successfully
treated with non-surgical interventions
The long-term effect of bariatric surgery was proven to be successful

with mean excess weight loss beyond 60%, but the short and long-
term surgical complication rate is relatively large

Three most common Bariatric Surgeries
LAGB: reversibility, simple but less effective
LRYGB: gold standard, high level of ef cacy
LSG: newer technique, easier to perform

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Ef cacy Outcomes
for Weight Reduction
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Ef cacy for Improvement in

Diabetes-Related Outcomes
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In summary, in addition to the effective weight loss

achieved by patients undergoing bariatric surgical
procedures, a substantial majority of patients with
diabetes, hyperlipidemia, hypertension, and obstructive
sleep apnea experienced complete resolution or
improvement of their comorbid condition
JAMA, October 13, 2004—Vol 292, No. 14

JAMA Surg. 2013;148(6):555-562. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1504

During a 6-year follow-up period of this privately insured

cohort, unable to identify any short- or long-term
reductions in overall health care costs associated with
surgery.
Suggests that to assess the value of bariatric surgery,

future studies should focus on the potential bene t of
improved health and well-being of persons undergoing the
procedure rather than on cost savings
JAMA Surg. 2013;148(6):555-562. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1504

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Obesity Surgery. https://doi.org/10.1007/s11695-018-3525-0. Published online: 6 October 2018
In summary, RYGB, LAGB and BPD/DS lead to substantial

weight loss which continues for at least 10 years
Long-term data on sleeve gastrectomy are modest at this

time
Guidance to the obese patient should balance durable

effectiveness with risks, costs, health bene ts and effect
on quality of life
Obesity Surgery. https://doi.org/10.1007/s11695-018-3525-0. Published online: 6 October 2018
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Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.
In summary, LSG has morbidity and effectiveness

positioned between the LAGB and the LRYGB/ORYGB for
data up to one year
As obesity is a lifelong disease, longer term comparative

effectiveness data are most critical, and are yet to be
determined

Obesity Surgery https://doi.org/10.1007/s11695-017-3100-0. Published online: 15 January 2018


LRYGB is the optimal bariatric technique, being the most

cost-effective compared to LSG, LAGB, and no surgery
However, LSG was the most cost-effective choice when

initial BMI ranged between 35 and 39.9 kg/m2

Thank You
@rudimansurgery

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Cost Effectiveness of

Perhimpunan Dokter Spesialis Bedah Digestif Indonesia

Bariatric surgery is a well-documented treatment for

But uncertainties about the degree to which such surgery

In 2008, approximately 1.4 billion adults were considered

Of the 1.4 billion adults, approximately 300 million women

Twelve million adults in the USA are considered morbidly

Riset Kesehatan Dasar (Riskedas) 2018:

North Sulawesi 30.2%

DKI Jakarta 29.8%

East Kalimantan 28.7%

A signi cant increase from 2007 (10.7%) & 2013 (11.5%)

Obesity Associated Problems

Obesity is associated with several comorbidities that increase

It is associated with hypertension, coronary artery disease,

Behavioral therapy, diet, and weight reduction medications have been

Bariatric surgery is considered as a treatment option for class III (BMI

The long-term effect of bariatric surgery was proven to be successful

Three most common Bariatric Surgeries

LAGB: reversibility, simple but less effective

LRYGB: gold standard, high level of ef cacy

LSG: newer technique, easier to perform

Ef cacy for Improvement in

In summary, in addition to the effective weight loss

JAMA, October 13, 2004—Vol 292, No. 14

JAMA Surg. 2013;148(6):555-562. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1504

During a 6-year follow-up period of this privately insured

Suggests that to assess the value of bariatric surgery,

JAMA Surg. 2013;148(6):555-562. Published online February 20, 2013. doi:10.1001/jamasurg.2013.1504

Obesity Surgery. https://doi.org/10.1007/s11695-018-3525-0. Published online: 6 October 2018

In summary, RYGB, LAGB and BPD/DS lead to substantial

Long-term data on sleeve gastrectomy are modest at this

Guidance to the obese patient should balance durable

Obesity Surgery. https://doi.org/10.1007/s11695-018-3525-0. Published online: 6 October 2018

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

In summary, LSG has morbidity and effectiveness

As obesity is a lifelong disease, longer term comparative

Hutter et al. Ann Surg. 2011 September ; 254(3): 410–422. doi:10.1097/SLA.0b013e31822c9dac.

Obesity Surgery https://doi.org/10.1007/s11695-017-3100-0. Published online: 15 January 2018

Obesity Surgery https://doi.org/10.1007/s11695-017-3100-0. Published online: 15 January 2018

LRYGB is the optimal bariatric technique, being the most

However, LSG was the most cost-effective choice when

Obesity Surgery https://doi.org/10.1007/s11695-017-3100-0. Published online: 15 January 2018

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