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

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 IIHWeight 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 pound, 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. (C) 2021 American Society for Bariatric Surgery. Published by Elsevier Inc.

Automated summary

This study demonstrates that compared to community weight management, bariatric surgery is a highly cost-effective treatment option for women with IIH and obesity. Surgery leads to long-term cost savings and health benefits, which become apparent after 5 years post surgery and continue to increase over time.