Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness
KCE Reports 316C (2019)
Bariatric operations (i.e. for the purpose of losing weight) have increased by more than 80% over the last seven years. In the majority of cases, these operations result in significant and lasting weight loss, along with a reduction in the risk of obesity-related death and an improvement in diabetes, which is often present in obese people. However, it is important to note that these are major, often irreversible operations which can cause serious complications. They involve a radical change in how a person eats, a lifelong medical monitoring, and the intake of food supplements to prevent nutritional deficiencies.
Currently, bariatric surgical operations are reimbursed only above the age of 18, with some rare exceptions. The first question put to KCE was whether it was appropriate to extend this reimbursement to include adolescents. When they become seriously obese, a condition often accompanied by high blood pressure or diabetes, their life expectancy is clearly shortened. KCE has concluded that such operations must remain exceptional and reserved for cases where the medical need is great.
Another question concerned people with diabetes (type 2). These individuals can usually obtain reimbursement if their body mass index (BMI) is at least 35, but the question is whether this threshold should be lowered to 30. KCE recommends authorising reimbursement at this level but linking it to a requirement to record data so that a subsequent assessment can be made on whether the improvement obtained is genuine and lasting.
This report was followed up, in 2020, with the publication of a detailed care plan for the overall care of patients undergoing bariatric surgery (see report 329).
How to refer to this report
