Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system

Laura Elliot; Emma Frew; Susan Mollan; James Mitchell; Andreas Yiangou; Zerin Alimajstorovic; Ryan Ottridge; Benjamin Wakerley; Mark Thaller; Olivia Grech; Rishi Singhal; Abd Tahrani; Mark Harrison; Alex Sinclair; Magda Aguiar

doi:10.1016/j.soard.2021.03.020

Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system

Laura Elliot, Emma Frew, Susan Mollan, James Mitchell, Andreas Yiangou, Zerin Alimajstorovic, Ryan Ottridge, Benjamin Wakerley, Mark Thaller, Olivia Grech, Rishi Singhal, Abd Tahrani, Mark Harrison, Alex Sinclair, Magda Aguiar

Research output: Contribution to journal › Article › peer-review

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Abstract

Background

Idiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established.

Objectives

To estimate the cost-effectiveness of weight-loss treatments for IIH.

Setting

Single-payer healthcare system (National Health Service, England).

Methods

A Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model.

Results

In the base case analysis, over a 20-year time horizon, bariatric surgery was “dominant,” led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness.

Conclusion

This economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time.

Original language	English
Pages (from-to)	P1310-1316
Journal	Surgery for Obesity and Related Diseases
Volume	17
Issue number	7
Early online date	30 Mar 2021
DOIs	https://doi.org/10.1016/j.soard.2021.03.020
Publication status	Published - 1 Jul 2021

Bibliographical note

Accepted manuscript online 30/03/2021. Final Version of Record not yet available as of 08/06/2021.

Funding Information:
This Trial was funded by grant NIHR-CS-001-028 (Clinician Scientist Fellowship) from the National Institute for Health Research (Dr Sinclair) and grant MR/K015184/1 from the Medical Research Council UK (Dr Sinclair). EF was funded by a National Institute for Health Research (NIHR) career development fellowship award (NIHR-CDF-2015-08-13) for the duration of the study. AJS was funded by an NIHR clinician scientist fellowship (NIHR-CS-011-028) for the duration of the study; is funded by a Sir Jules Thorn Award for Biomedical Science; and reports personal fees from Invex therapeutics, during the conduct of the study but outside the submitted work. AAT was funded by an NIHR Clinician Scientist Award for part of the duration of the study (CS-2013-13-029) and reports grants from Novo Nordisk, personal fees from Novo Nordisk, nonfinancial support from Novo Nordisk, personal fees from Eli Lilly, nonfinancial support from Eli Lilly, personal fees from Janssen, personal fees from AZ, nonfinancial support from AZ, nonfinancial support from Impeto medical, nonfinancial support from Resmed, nonfinancial support from Aptiva, personal fees from BI, nonfinancial support from BI, personal fees from BMS, nonfinancial support from BMS, personal fees from NAPP, nonfinancial support from NAPP, personal fees from MSD, nonfinancial support from MSD, grants from Sanofi, and personal fees from Sanofi. SPM reports other Invex Therapeutics, other Heidelberg engineering during the conduct of the study; other from Chugai-Roche Ltd, other from Janssen, other from Allergan, other from Santen, other from Roche, and other from Neurodiem, outside the submitted work. OG reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. BRW reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. All other authors declare no competing interests. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK department of Health and Social Care.

Funding Information:
We acknowledge Birmingham Clinical Trials Unit (BCTU) for trial coordination and data management. We acknowledge support from the Medical Research Council (MRC UK) and the National Institute for Health Research (NIHR UK) who funded the IIH:WT trial, the NIHR Clinical Research Network and the Wellcome Trust Clinical Research Facilities, where IIH:WT was performed.

Keywords

Bariatric surgery
Cost-effectiveness
Idiopathic intracranial hypertension
Weight loss

ASJC Scopus subject areas

Surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.soard.2021.03.020Licence: Creative Commons: Attribution (CC BY)

PIIS1550728921001556Final published version, 595 KBLicence: Creative Commons: Attribution (CC BY)

Assessing the Therapeutic Efficacy of an 11Beta-Hydroxysteroid Dehydrogenase Type 1 Inhibitor (AZD4017) in Idiopathic Intracranial Hypertension (IIH)
Sinclair, A., Tomlinson, J. & Stewart, P.
Medical Research Council
12/08/13 → 11/08/17
Project: Research Councils
Sustained treatment of Idiopathic Intracranial Hypertension (IIH) through weight loss induced by bariatric surgery
Sinclair, A.
NIHR TRAINEES COORDINATING CENTRE
1/06/13 → 31/10/18
Project: Research

Cite this

Elliot, L., Frew, E., Mollan, S., Mitchell, J., Yiangou, A., Alimajstorovic, Z., Ottridge, R., Wakerley, B., Thaller, M., Grech, O., Singhal, R., Tahrani, A., Harrison, M., Sinclair, A., & Aguiar, M. (2021). Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system. Surgery for Obesity and Related Diseases, 17(7), P1310-1316. Advance online publication. https://doi.org/10.1016/j.soard.2021.03.020

@article{70b294f1c8aa4d47a8409e64cfbe959c,

title = "Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system",

abstract = "BackgroundIdiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established.ObjectivesTo estimate the cost-effectiveness of weight-loss treatments for IIH.SettingSingle-payer healthcare system (National Health Service, England).MethodsA Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model.ResultsIn the base case analysis, over a 20-year time horizon, bariatric surgery was “dominant,” led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness.ConclusionThis economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time.",

keywords = "Bariatric surgery, Cost-effectiveness, Idiopathic intracranial hypertension, Weight loss",

author = "Laura Elliot and Emma Frew and Susan Mollan and James Mitchell and Andreas Yiangou and Zerin Alimajstorovic and Ryan Ottridge and Benjamin Wakerley and Mark Thaller and Olivia Grech and Rishi Singhal and Abd Tahrani and Mark Harrison and Alex Sinclair and Magda Aguiar",

note = "Accepted manuscript online 30/03/2021. Final Version of Record not yet available as of 08/06/2021. Funding Information: This Trial was funded by grant NIHR-CS-001-028 (Clinician Scientist Fellowship) from the National Institute for Health Research (Dr Sinclair) and grant MR/K015184/1 from the Medical Research Council UK (Dr Sinclair). EF was funded by a National Institute for Health Research (NIHR) career development fellowship award (NIHR-CDF-2015-08-13) for the duration of the study. AJS was funded by an NIHR clinician scientist fellowship (NIHR-CS-011-028) for the duration of the study; is funded by a Sir Jules Thorn Award for Biomedical Science; and reports personal fees from Invex therapeutics, during the conduct of the study but outside the submitted work. AAT was funded by an NIHR Clinician Scientist Award for part of the duration of the study (CS-2013-13-029) and reports grants from Novo Nordisk, personal fees from Novo Nordisk, nonfinancial support from Novo Nordisk, personal fees from Eli Lilly, nonfinancial support from Eli Lilly, personal fees from Janssen, personal fees from AZ, nonfinancial support from AZ, nonfinancial support from Impeto medical, nonfinancial support from Resmed, nonfinancial support from Aptiva, personal fees from BI, nonfinancial support from BI, personal fees from BMS, nonfinancial support from BMS, personal fees from NAPP, nonfinancial support from NAPP, personal fees from MSD, nonfinancial support from MSD, grants from Sanofi, and personal fees from Sanofi. SPM reports other Invex Therapeutics, other Heidelberg engineering during the conduct of the study; other from Chugai-Roche Ltd, other from Janssen, other from Allergan, other from Santen, other from Roche, and other from Neurodiem, outside the submitted work. OG reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. BRW reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. All other authors declare no competing interests. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK department of Health and Social Care. Funding Information: We acknowledge Birmingham Clinical Trials Unit (BCTU) for trial coordination and data management. We acknowledge support from the Medical Research Council (MRC UK) and the National Institute for Health Research (NIHR UK) who funded the IIH:WT trial, the NIHR Clinical Research Network and the Wellcome Trust Clinical Research Facilities, where IIH:WT was performed.",

year = "2021",

month = jul,

day = "1",

doi = "10.1016/j.soard.2021.03.020",

language = "English",

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pages = "P1310--1316",

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Elliot, L, Frew, E , Mollan, S, Mitchell, J, Yiangou, A , Alimajstorovic, Z, Ottridge, R, Wakerley, B, Thaller, M, Grech, O, Singhal, R, Tahrani, A, Harrison, M, Sinclair, A & Aguiar, M 2021, 'Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system', Surgery for Obesity and Related Diseases, vol. 17, no. 7, pp. P1310-1316. https://doi.org/10.1016/j.soard.2021.03.020

Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system. / Elliot, Laura; Frew, Emma ; Mollan, Susan et al.
In: Surgery for Obesity and Related Diseases, Vol. 17, No. 7, 01.07.2021, p. P1310-1316.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension

T2 - evidence from a single payer health care system

AU - Elliot, Laura

AU - Frew, Emma

AU - Mollan, Susan

AU - Mitchell, James

AU - Yiangou, Andreas

AU - Alimajstorovic, Zerin

AU - Ottridge, Ryan

AU - Wakerley, Benjamin

AU - Thaller, Mark

AU - Grech, Olivia

AU - Singhal, Rishi

AU - Tahrani, Abd

AU - Harrison, Mark

AU - Sinclair, Alex

AU - Aguiar, Magda

N1 - Accepted manuscript online 30/03/2021. Final Version of Record not yet available as of 08/06/2021. Funding Information: This Trial was funded by grant NIHR-CS-001-028 (Clinician Scientist Fellowship) from the National Institute for Health Research (Dr Sinclair) and grant MR/K015184/1 from the Medical Research Council UK (Dr Sinclair). EF was funded by a National Institute for Health Research (NIHR) career development fellowship award (NIHR-CDF-2015-08-13) for the duration of the study. AJS was funded by an NIHR clinician scientist fellowship (NIHR-CS-011-028) for the duration of the study; is funded by a Sir Jules Thorn Award for Biomedical Science; and reports personal fees from Invex therapeutics, during the conduct of the study but outside the submitted work. AAT was funded by an NIHR Clinician Scientist Award for part of the duration of the study (CS-2013-13-029) and reports grants from Novo Nordisk, personal fees from Novo Nordisk, nonfinancial support from Novo Nordisk, personal fees from Eli Lilly, nonfinancial support from Eli Lilly, personal fees from Janssen, personal fees from AZ, nonfinancial support from AZ, nonfinancial support from Impeto medical, nonfinancial support from Resmed, nonfinancial support from Aptiva, personal fees from BI, nonfinancial support from BI, personal fees from BMS, nonfinancial support from BMS, personal fees from NAPP, nonfinancial support from NAPP, personal fees from MSD, nonfinancial support from MSD, grants from Sanofi, and personal fees from Sanofi. SPM reports other Invex Therapeutics, other Heidelberg engineering during the conduct of the study; other from Chugai-Roche Ltd, other from Janssen, other from Allergan, other from Santen, other from Roche, and other from Neurodiem, outside the submitted work. OG reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. BRW reports consulting work for Invex Therapeutics during the conduct of the study but outside the submitted work. All other authors declare no competing interests. The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK department of Health and Social Care. Funding Information: We acknowledge Birmingham Clinical Trials Unit (BCTU) for trial coordination and data management. We acknowledge support from the Medical Research Council (MRC UK) and the National Institute for Health Research (NIHR UK) who funded the IIH:WT trial, the NIHR Clinical Research Network and the Wellcome Trust Clinical Research Facilities, where IIH:WT was performed.

PY - 2021/7/1

Y1 - 2021/7/1

N2 - BackgroundIdiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established.ObjectivesTo estimate the cost-effectiveness of weight-loss treatments for IIH.SettingSingle-payer healthcare system (National Health Service, England).MethodsA Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model.ResultsIn the base case analysis, over a 20-year time horizon, bariatric surgery was “dominant,” led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness.ConclusionThis economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time.

AB - BackgroundIdiopathic intracranial hypertension (IIH) is associated with significant morbidity, predominantly affecting women of childbearing age living with obesity. Weight loss has demonstrated successful disease-modifying effects; however, the long-term cost-effectiveness of weight loss interventions for the treatment of IIH has not yet been established.ObjectivesTo estimate the cost-effectiveness of weight-loss treatments for IIH.SettingSingle-payer healthcare system (National Health Service, England).MethodsA Markov model was developed comparing bariatric surgery with a community weight management intervention over 5-, 10-, and 20-year time horizons. Transition probabilities, utilities, and resource use were informed by the IIH Weight Trial (IIH:WT), alongside the published literature. A probabilistic sensitivity analysis was conducted to characterize uncertainty within the model.ResultsIn the base case analysis, over a 20-year time horizon, bariatric surgery was “dominant,” led to cost savings of £49,500, and generated an additional 1.16 quality-adjusted life years in comparison to the community weight management intervention. The probabilistic sensitivity analysis indicated a probability of 98% that bariatric surgery is the dominant option in terms of cost-effectiveness.ConclusionThis economic modeling study has shown that when compared to community weight management, bariatric surgery is a highly cost-effective treatment option for IIH in women living with obesity. The model shows that surgery leads to long-term cost savings and health benefits, but that these do not occur until after 5 years post surgery, and then gradually increase over time.

KW - Bariatric surgery

KW - Cost-effectiveness

KW - Idiopathic intracranial hypertension

KW - Weight loss

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U2 - 10.1016/j.soard.2021.03.020

DO - 10.1016/j.soard.2021.03.020

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SN - 1550-7289

VL - 17

SP - P1310-1316

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

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ER -

Elliot L, Frew E , Mollan S, Mitchell J, Yiangou A , Alimajstorovic Z et al. Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system. Surgery for Obesity and Related Diseases. 2021 Jul 1;17(7):P1310-1316. Epub 2021 Mar 30. doi: 10.1016/j.soard.2021.03.020

Cost-effectiveness of bariatric surgery versus community weight management to treat obesity-related idiopathic intracranial hypertension: evidence from a single payer health care system

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Fingerprint

Projects

Assessing the Therapeutic Efficacy of an 11Beta-Hydroxysteroid Dehydrogenase Type 1 Inhibitor (AZD4017) in Idiopathic Intracranial Hypertension (IIH)

Sustained treatment of Idiopathic Intracranial Hypertension (IIH) through weight loss induced by bariatric surgery

Cite this