Bariatric surgery

On October 15, 2020, the French National Authority for Health (HAS) published the report “New techniques of bariatric surgery: identification, the status of advancement and opportunities to evaluate,” in which they outlined three techniques currently diffusing in France (SADI-Sleeve, Endosleeve, and Sleeve Gastrectomy with Transit Bipartition). All three methods are the subject of ongoing clinical studies, and the evaluation will be initiated at the end of these studies.

In August 2020, the network of European HTA agencies, EUnetHTA, announced the final plan of the project OTCA26 “Surgical procedures for treatment of obesity.” The key question of the assessment is bariatric surgery for the treatment of adults with obesity.

In early September 2019, the Innovation Committee of the Federal Joint Committee (G-BA) has published an overview of new research projects in the area of health services to be funded by the Innovation Fund in the future.

In September 2019, the French High Authority for Health (HAS) released an assessment report for gastric bypass, also known as omega loop in severe obesity. The evaluation aimed to compare omega-loop gastric bypass (OLGB) with Roux-en-Y Gastric Bypass (RYGB) in terms of efficacy and safety. OLGB cannot be determined as an alternative treatment to RYGB considering the safety aspects due to a lack of efficacy and safety data. The method should be studied in a framework of clinical research.

In June 2019, the Belgian Health Care Knowledge Center (KCE) published a report of the health technology assessment of bariatric surgery.

In mid-February 2019, the Swiss conference of cantonal healthcare directors (GDK/CDS) has published information about allocation of hospitals for highly complex visceral surgery in the fields of oesophageal, pancreatic and hepatic resections.

In early February 2019, the entity that performs health technology assessment for medical devices in Italy, AGENAS, has called for the voluntary contribution of the clinical experts and/or reviewers, as well as for the participation of the manufacturers for announced that they’re working on several HTA projects on different medical devices and procedures, including bariatric surgery, continuous glucose monitoring, Elecsys®sFlt-1/PlGF test and others.

In January, the Danish Health Authority published new codes for the Health Care Classification System, including eight surgical, three medical codes and three codes for imaging diagnostics. These codes are used to classify procedures in the Danish DRG system.

The report presents a summary of the reimbursement situation for bariatric surgery. Report includes analysis for placement of adjustable gastric band, sleeve gastrectomy, and gastric bypass. The analysis covers procedure coding, payment mechanism, reimbursement tariffs and policy restrictions in 11 EU countries including Austria, Belgium, Denmark, England, France, Germany, Italy, the Netherlands, Norway, Sweden and Switzerland.

In mid-June 2018, the Spanish Network of Agencies for Assessing National Health System Technologies and Performance (REDETS) has published a report on the efficacy and safety of bariatric surgery in morbidly obese patients.

Article “Cost-effectiveness analysis of bariatric surgery for morbid obesity in Belgium” published in the “Journal of Medical Economics” provides insights about economic outcomes of bariatric surgery in Belgium using Markov modeling. Over the 10-year horizon, bariatric surgery led to a cost increment of €3,788 and 1.4 additional QALY (€2,809/QALY) compared with optimal medical management. Over lifetime horizon, surgery led to 1.1 life years and 5.0 QALY gains and €9,332/patient average cost savings.

Article “Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis” published in the “Expert Review of Pharmacoeconomics & Outcomes Research” provides insights about economic outcomes of bariatric surgery in Spain using Markov modeling. Over the 10-year horizon, bariatric surgery led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY) compared with optimal medical management. Over lifetime horizon, surgery led to 0.6 life years and 4.4 QALY gains and €300/patient average cost savings.