A new NIHR-supported study has found that gastric bypass surgery is the most effective and cost-efficient option for treating severe obesity
University of Bristol researchers worked with the NIHR to lead the By-Band-Sleeve trial, the largest completed trial of its kind, to understand the clinical and cost-effectiveness of three metabolic and bariatric surgery types.
The results are published in the Lancet Diabetes & Endocrinology.
Gastric bypass provides the best value for money
The researchers compared Roux-en-Y gastric bypass with two other metabolic and bariatric surgery types in 1,346 patients. They were adjustable gastric banding and sleeve gastrectomy.
Gastric bypass and gastric band were commonly performed in the UK and worldwide when the trial started. Gastric sleeves were performed by surgeons more often during the first two years of the trial.
The researchers found gastric bypass to be the most clinically and cost-effective for patients, providing the best value for money for the NHS three years after surgery.
Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “Obesity is one of the biggest challenges facing us globally and in the UK. This treatment will help save lives and improve the quality of life for patients while providing better value for money for the NHS.
“NIHR-funded trial results provide vital evidence that gastric bypass improves the quality of life for UK patients and helps clinicians and those providing NHS and care services choose the best treatments.
“The findings demonstrate how our life-changing NIHR research, funded by the public, has an impact on supporting the health and care sector to achieve more effective and efficient use of resources.”
68% of bypass patients lost 50% or more of their excess weight
The trial found that 68% (276) of participants randomised to bypass achieved at least 50% excess weight loss after three years. The gastric band achieved 25% (97) and 41% (141) for the gastric sleeve.
Participants lost 26.5kg on average, with some losing up to 98kg. Less than 10% gained weight during the trial.
The gastric bypass also led to a more significant reduction in comorbidities, such as high blood pressure. The researchers also found the most cost-effective when accounting for patients’ quality of life, when using the NICE standard UK cost threshold. Despite the gastric bypass being the costliest to perform, it led to a better quality of life and lower healthcare costs after three years compared to the other two surgeries.
The researchers also emphasise the importance of comparing surgery with obesity management medications (OMMs) to provide evidence to inform patients, surgeons and the NHS entirely.
Jane Blazeby, Professor of Surgery at the University of Bristol, who led the trial, said: “Based on the trial findings, we recommend patients electing to have bariatric and metabolic surgery are advised to have a bypass. Sleeve should be a secondary option when bypass is not possible. Our evidence does not support band as the standard treatment for people living with severe obesity.
“The hard work undertaken by all the study participants, surgeons, nurses and dieticians means we now have reliable information to inform NHS practice. The next challenge is for surgical teams to work with researchers and physicians to conduct a new study that compares surgery to weight loss drugs to create evidence to understand how they compare surgery in terms of weight loss, quality of life and costs.”
