Introduction: Obesity is associated with a number of comorbidities which deteriorate health status and are costly to manage. We are interested in assessing the cost-effectiveness of the two most common bariatric procedures, the sleeve gastrectomy, and roux-en-y gastric bypass (RYGB) for reducing comorbidity rates and costs. With the entry of new weight-loss medications to market, this long-term data will serve as a benchmark to compare therapies as outcome data become available.

Methods: A meta-analysis was submitted to PROSPERO and performed utilizing Ovid Medline. A total of 53 articles were identified which met quality and inclusion criteria. Data were extracted for a total of 113,762 patients. Utility values, procedural and annual comorbidity cost data were extracted from literature and adjusted for inflation. A cost-utility analysis model was constructed for each of these data trends, to a maximal of 20-years post-operatively.

Results: At 10 years post-RYGB or sleeve, patients had significant and sustained BMI decreases of 15.9 and 11.1 points respectively as compared to 1.3 points for mixed medical/diet control. RYGB data at 20 years, demonstrated a sustained decrease of 17.8 points, compared to control at 1.9. At 10 years RYGB patients had a 12.3% reduction in DM, sleeve a 10.5% reduction, compared to a 12.8% increase in the control group. At 12 years, DM prevalence in RYGB was decreased by 14.9% whereas the control group had increased by 16.1%. At 10 years there was a net-positive cost of $946 for RYGB and $7,623 for sleeve, with QALY gain of 1.04 and 0.74 and ICER of $909/QALY and $10,262/QALY respectively. BMI and DM data were available for RYGB at 12 years, where a net cost-savings for RYGB of $6,129 per patient and 1.28 utility gain was observed.

Conclusion: While bariatric surgery may be viewed as having a high initial cost, this study demonstrates that these procedures are not only cost-effective, they are cost sparing. At 10 years this study demonstrates ICER at $909/QALY for RYGB and $10,262/QALY for sleeve gastrectomy, qualifying them as extremely cost-effective procedures. At the 12-year mark, RYGB was cost negative with a net savings of $6,129 per patient. In addition to these cost-savings, both procedures demonstrate a major reduction in type 2 diabetes and BMI, which cannot be overstated for the unquantified subjective impact on quality of life. Future work will include addition of other comorbidities and the impact of complications of both medical and surgical therapy.