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Incremental Cost-Effectiveness of Aspiration Therapy vs Bariatric Surgery and No Treatment for Morbid Obesity

Mital, Shweta MSc1; Nguyen, Hai V. PhD1

American Journal of Gastroenterology: September 2019 - Volume 114 - Issue 9 - p 1470–1477
doi: 10.14309/ajg.0000000000000359

INTRODUCTION: Despite its recent approval by the US Food and Drug Administration and Health Canada, aspiration therapy—one of the latest weight loss treatments—remains controversial. Critics have expressed concerns that the therapy could lead to bulimia and other binge eating disorders. Meanwhile, proponents argue that the therapy is less invasive, reversible, and cheaper than bariatric surgery. Cost-effectiveness of this therapy, however, is not yet established.

METHODS: We developed a Markov model to estimate the incremental cost-effectiveness of aspiration therapy relative to 2 most common bariatric surgery procedures (gastric bypass and sleeve gastrectomy) and no treatment over a lifetime horizon. Costs were estimated from the health system's perspective using US data. Effectiveness was measured in terms of quality-adjusted life-years (QALYs).

RESULTS: Despite being a cheaper procedure than bariatric surgery, aspiration therapy costs more than bariatric surgery in the long term because of its high maintenance costs (i.e., periodic replacement of device parts). It also yields lower QALYs than bariatric surgery because of its smaller weight loss effects. Thus, the therapy is dominated by bariatric surgery. In particular, compared with gastric bypass, it costs US$5,318 more and yields 1.31 fewer QALYs. However, aspiration therapy is cost-effective relative to no treatment with an incremental cost-effectiveness ratio of US$17,532 per QALY gained.

DISCUSSION: Given its high lifetime costs and its modest weight loss effects, aspiration therapy is not cost-effective relative to bariatric surgery. However, it is a cost-effective treatment option for patients who lack access to bariatric surgery.

1School of Pharmacy, Memorial University of Newfoundland, St. John's, Canada.

Correspondence: Hai V. Nguyen. E-mail:

SUPPLEMENTARY MATERIAL accompanies this article at

Received December 21, 2018

Received in revised form May 08, 2019

Accepted July 11, 2019

Online date: August 20, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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