Cost-effectiveness of interventions for the management of severe obesity (findings from the REBALANCE study
PHE ePoster Library. Jacobsen E. Apr 10, 2019; 259620
Elisabet Jacobsen
Elisabet Jacobsen
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Abstract
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Abstract Introduction

: Severe obesity (BMI ≥35kg/m2) is a major public health concern. Despite the substantial health, social and economic burden of obesity related diseases, there is little evidence-based guidance regarding the most effective and cost-effective treatment options.

Methods:

The UK Health Forum's micro-simulation model, was used to compare the costs, outcomes, and cost-effectiveness of 4 different weight management programmes (WMPs) - (the Look AHEAD intensive WMP; two other moderate intensity WMPs [WMP1 and WMP2], and a very-low calorie diet (VLCD) added to a moderate intensity WMP [WMP1) and Roux-en-Y (RYGB) surgery against current UK population obesity trends. Interventions were micro-costed and BMI change data were obtained from meta-analyses of randomised controlled trials. For WMPs, baseline weight was assumed to be regained linearly over five years. For RYGB longer term weight loss maintenance was assumed.Results are reported as incremental cost per QALY gained, over a 30 year time horizon, from a UK NHS healthcare perspective. Sensitivity analysis explored the impact of different weight regain assumptions on the results.

Results:

All WMPs were cost-effective compared with current UK population obesity trends (The base case ICERs for WMP1, WMP2 and the Look AHEAD WMP were £488, £1,541 and £23,915 respectively). However, adding a VLCD to WMP 1 was not cost-effective. RYGB including follow-up, cost ~£20,000 per individual to deliver, but also generated the greatest QALY gains (ICER = £10,126 / QALY). Results for WMPs were particularly sensitive to the modelled weight regain assumptions.

Conclusions:

RYGB surgery is costly, but provides the greatest weight loss and QALY gains, and is the most cost-effective strategy overall. In scenarios where surgery may not be feasible, desired, or appropriate, WMPs also offer a cost-effective alternative compared to current obesity trends. Funding This project was funded by the NIHR Health Technology Assessment Programme (Project number: 15/09/04)
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