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Quality-adjusted life expectancy benefits of laparoscopic bariatric surgery: A United States perspective

Published online by Cambridge University Press:  29 June 2010

Lyndon V. Hernandez  and
Dominic Klyve
Lyndon V. Hernandez
Affiliation:
Harvard School of Public Health and Aurora Medical Center–Kenosha
Dominic Klyve
Affiliation:
Carthage College
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Abstract

Objectives: The method of choice for bariatric surgery remains controversial. The aim of this study was to compare the outcome of laparoscopic Roux-en-Y gastric bypass (L-RYGB) versus laparoscopic adjustable gastric banding (LAGB) using quality-adjusted life-years (QALYs).

Methods: We developed a Markov model of the quality of life and survival of L-RYGB and LAGB in obese patients. Using census data, we estimated the probability of dying and quality of life for each year of each cohort.

Results: For all cohorts, L-RYGB offers the highest advantage in QALYs compared with gastric banding. The youngest cohort showed the greatest discrepancy between the two surgical methods, with 7.8, 6.4, and 4.7 QALYs gained with L-RYGB over LAGB for the age groups 35, 45, and 55, respectively. Those with the highest presurgical body mass index (BMI) acquired the most advantage with L-RYGB, with 2.8, 6.4, and 9.6 QALYs gained with L-RYGB over LAGB for the BMI groups 40, 50, and 60. Males had a slightly higher advantage with L-RYGB, with 6.5 QALYs gained with L-RYGB over LAGB compared with 6.0 QALYs for females.

Conclusions: For the cohorts studied, L-RYGB is the preferred surgical treatment for obesity if the sole metric is QALYs. The young and extremely obese are core groups who will gain the most QALYs following L-RYGB.

Keywords

laparoscopic Roux-en-Y gastric bypass (L-RYGB)laparoscopic adjustable gastric banding (LAGB)Quality-adjusted life-years (QALYs)Markov modelObesity
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 3 , July 2010 , pp. 280 - 287
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1. Angrisani, L, Lorenzo, M, Borrelli, V. Laparoscopic adjustable gastric banding versus Roux-en-Y gastric bypass: 5-year results of a prospective randomized trial. Surg Obes Relat Dis. 2007;3:127–132.CrossRefGoogle ScholarPubMed
2. Bowne, WB, Julliard, K, Castro, AE, et al. Laparoscopic gastric bypass is superior to adjustable gastric band in super morbidly obese patients: A prospective, comparative analysis. Arch Surg. 2006;141:683–689.CrossRefGoogle ScholarPubMed
3. Branson, R, Potoczna, N, Brunotte, R, et al. Impact of age, sex and body mass index on outcomes at four years after gastric banding. Obes Surg. 2005;15:834–842.Google Scholar
4. Buchwald, H, Estok, R, Fahrbach, K, Banel, D, Sledge, I. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery. 2007;142:621–632; discussion 632–635.CrossRefGoogle ScholarPubMed
5. Cottam, DR, Atkinson, J, Anderson, A, et al. A case-controlled matched pair cohort study of laparoscopic Roux-en-Y gastric bypass and Lap-Band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534–540.CrossRefGoogle Scholar
6. Craig, BM, Tseng, DS. Cost-effectiveness of gastric bypass for severe obesity. Am J Med. 2002;113:491–498.Google Scholar
7. Fontaine, KR, Redden, DT, Wang, C, Westfall, AO, Allison, DB. Years of life lost due to obesity. JAMA. 2003;289:187–193.Google Scholar
8. Hakim, Z, Wolf, A, Garrison, LP. Estimating the effect of changes in body mass index on health state preferences. Pharmacoeconomics. 2002;20:393–404.CrossRefGoogle ScholarPubMed
9. Hauptman, J, Lucas, C, Boldrin, MN, et al. Orlistat in the longterm treatment of obesity in primary care settings. Arch Fam Med. 2000;9:160–167.Google Scholar
10. Heo, M, Faith, MS, Mott, JW, et al. Hierarchical linear models for the development of growth curves: An example with body mass index in overweight/obese adults. Stat Med. 2003;22:1911–1942.CrossRefGoogle ScholarPubMed
11. Hinojosa, MW, Varela, JE, Parikh, D, et al. National trends in use and outcome of laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2009;5:150–155.CrossRefGoogle ScholarPubMed
12. Livingston, EH. Hospital costs associated with bariatric procedures in the United States. Am J Surg. 2005;190:816–820.CrossRefGoogle ScholarPubMed
13. Ma, Y, Pagoto, SL, Olendzki, BC, et al. Predictors of weight status following laparoscopic gastric bypass. Obes Surg. 2006;16:1227–1231.CrossRefGoogle ScholarPubMed
14. Martin, LF, Lundberg, AP, Juneau, F, Raum, WJ, Hartman, SJ. Surgery. A description of morbidly obese state employees requesting a bariatric operation. Surgery. 2005;138:690–700.Google Scholar
15. National Institutes of Health. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115:956–961.CrossRefGoogle Scholar
16. Netuveli, G, Wiggins, RD, Hildon, Z, Montgomery, SM, Blane, D. Quality of life at older ages: Evidence from the English longitudinal study of aging (wave 1). J Epidemiol Community Health. 2006;60:357–363.Google Scholar
17. NHANES III. http://www.soph.uab.edu/statgenetics/research/tables/yll.htm (accessed March, 2009).Google Scholar
18. Patterson, EJ, Urbvach, DR, Swanström, LL. A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: A decision analysis model. J Am Coll Surg. 2003;196:379–384.Google Scholar
19. Pope, GD, Finlayson, SR, Kemp, JA, Birkmeyer, JD. Life expectancy benefits of gastric bypass surgery. Surg Innov. 2006;13:265–273.CrossRefGoogle ScholarPubMed
20. Powers, KA, Rehrig, ST, Jones, DB. Financial impact of obesity and bariatric surgery. Med Clin North Am. 2007;91:321–338, ix.Google Scholar
21. Puzziferri, N, Nakonezny, PA, Livingston, EH, et al. Variations of weight loss following gastric bypass and gastric band. Ann Surg. 2008;248:233–242.CrossRefGoogle ScholarPubMed
22. Salem, L, Devlin, A, Sullivan, SD, Flum, DR. Cost-effectiveness analysis of laparoscopic gastric bypass, adjustable gastric banding, and nonoperative weight loss interventions. Surg Obes Relat Dis. 2008;4:26–32.Google Scholar
23. Santry, HP, Gillen, DL, Lauderdale, DS. Trends in bariatric surgical procedures. JAMA. 2005;294:1909–1917.CrossRefGoogle ScholarPubMed
24. Sendi, P, Palmer, AJ, Hauri, P, Craig, BA, Horber, FF. Modeling the impact of adjustable gastric banding on survival in patients with morbid obesity. Obes Res. 2002;10:291–295.Google Scholar
25. Statistics Related to Overweight and Obesity. NIDDK Weight-control Information Center. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health; 2003. NIH Publication No. 03-4158.Google Scholar
26. Tice, JA, Karliner, L, Walsh, J, Petersen, AJ, Feldman, MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121:885–893.Google Scholar
27. Tice, JA, Karliner, L, Walsh, J, Petersen, AJ, Feldman, MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2009;122:e9; author reply e11.Google Scholar
28. Tucker, DM, Palmer, AJ, Valentine, WJ, Roze, S, Ray, JA. Counting the costs of overweight and obesity: Modeling clinical and cost outcomes. Curr Med Res Opin. 2006;22:575–586.CrossRefGoogle ScholarPubMed
29. Tuma, RS. Stimulus funds force hard look at comparative effectiveness research. J Natl Cancer Inst. 2009;101:1036–1039.Google Scholar
30. Weller, WE, Rosati, C. Comparing outcomes of laparoscopic versus open bariatric surgery. Ann Surg. 2008;248:10–15.CrossRefGoogle ScholarPubMed