Purpose: Obesity and its associated comorbid conditions pose a grave threat to public health in the United States. Surgical therapy offers the only effective intervention that provides sustained weight loss and reduces the debilitating sequelae of morbid obesity. Data from the American Society for Bariatric Surgery indicate that Open Gastric Bypass (OGBP) and Laparoscopic Gastric Bypass (LGBP) comprised 85% of the estimated 140,600 procedures performed for morbid obesity in 2004; 10% of these patients underwent Laparoscopic Adjustable Gastric Banding (LAGB). Even though an increasing number of operations are performed each year, no study has examined the comparative cost effectiveness (CE) of these three operations in the United States.

Methods: Semi-Markov models were developed in TreeAge Pro 2005 to compare the CE of OGBP, LGBP, and LAGB. Best available data for each procedure were used to quantitate impact over a 5 year time horizon on body mass index (BMI), comorbidities, cost, quality of life, complications, additional procedures, and productivity loss. First order Monte Carlo simulations were used to evaluate the base case CE from the societal perspective and to perform linear sensitivity analyses for identification of important factors.

Results: Base case analysis (Caucasian woman age 42 and BMI of 51 kg/m²) revealed 5 year costs (in 2004 dollars) of $45,100(OGBP), $40,400(LGBP), and $30,200(LAGB). Costs per quality adjusted life year (QALY) were $12,300/QALY(OGBP), $10,700/QALY(LGBP), and $7,100/QALY(LAGB). All procedures showed increased CE with preoperative BMI above 53 kg/m². LAGB was both least costly and most effective in comparison to the other procedures regardless of gender or race. LGBP was the cost effective option when the probability of LAGB intolerance exceeded 32% or band slippage surpassed 28% at 5 years. Race, OGBP incisional hernia and LGBP anastomotic stricture had minimal impact on CE.

Conclusion: LAGB was the most cost effective option for morbid obesity considering currently available data over 5 postoperative years. These results were robust over a wide range of postoperative scenarios. Preoperative BMI, LAGB intolerance and slippage were important factors that influenced CE. Since LAGB comprises only 10% of the total procedures performed for morbid obesity, consideration should be given to increased use of this operation in the treatment of morbid obesity as more data become available for long term analyses.