Health state utilities for economic evaluation of bariatric surgery: A comprehensive systematic review and meta‐analysis

Abstract

Health state utilities (HSUs) are health economic metrics that capture and assess health‐related quality of life (HRQoL). They are essential in health‐economic evaluations when calculating quality‐adjusted life years. We investigated published studies reporting bariatric surgery‐related HSUs elicited through direct or indirect (multiattribute utility instrument [MAUI]) patient‐reported methods (PROSPERO registration number: CRD42019131725). Mean HSUs for different time points and HSU changes over time (where feasible) were meta‐analysed using random‐effects models. Of the 950 potentially relevant identified studies, n = 28 (2004–2018) qualified for data extraction, with n = 85 unique HSUs elicited mainly from the EQ‐5D (88%). Most (75%) studies were published after 2013. The follow‐up duration varied between studies and was often limited to 12 months. The pooled mean HSU was 0.72 (0.67–0.76) at baseline/presurgery (n = 18) and 0.84 (0.79–0.89) one‐year postsurgery (n = 11), indicating a 0.11 (0.09–0.14) utility unit increment. EQ‐5D showed the similar results. This positive difference can be partially explained by BMI and/or co‐morbidities status improvement. This study provides a valuable summary of HSUs to future bariatric surgery‐related cost‐utility models. However, more well‐designed higher‐quality bariatric‐related HSU studies are expected for future reviews to improve the available evidence. We suggest that researchers select an MAUI that is preferentially sensitive to the study population.