OBJECTIVES: Obesity is a challenge to health systems owing to the burden of comorbidities. In this study, we aimed to evaluate the cost-effectiveness of different bariatric surgeries (Laparoscopic Sleeve Gastrectomy (LSG), Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), and One-Anastomosis Gastric Bypass (OAGB)) in comparison with no surgery in the treatment of obesity, from the perspective of the Universal Health Insurance Authority (UHIA) in Egypt.

METHODS: A patient-level simulation model was developed to estimate the cost-effectiveness of bariatric surgery over the lifetime horizon. The model utilized a specifically designed patient generator to create a cohort reflecting the characteristics of the obese population in Egypt, accounting for the correlations between 51 patient characteristics. The model included 16 obesity-related comorbidities, particularly diabetes and its microvascular and macrovascular complications. Diabetes treatment pathways were based on UHIA guidelines. Also, the impact of diabetes medications on outcomes was modeled. Economic outcomes included costs per quality-adjusted life-year (QALYs). Clinical outcomes included body mass index (BMI), diabetes complications, obesity-related comorbidities, and event-free survival.

RESULTS: All surgical interventions were dominant compared with no surgery; they were both more effective and less costly. LSG resulted in cost savings of EGP 15,587 and an additional 2.32 QALYs. LRYGB saved EGP 8,882 with an additional 2.76 QALYs. OAGB saved EGP 3,287 with an incremental 2.63 QALYs. The average patient survival increased by 3.4 years with LSG, 3.9 years with LRYGB, and 3.8 years with OAGB compared with no surgery. Also, event-free survival for different comorbidities significantly increased in the surgical arms.

CONCLUSIONS: Bariatric surgeries represent cost-effective treatment options for obese patients. They can reduce different obesity- related complications and offer cost savings. Thus, bariatric surgeries may help the healthcare systems reduce the burden of obesity.