Obesity is a serious risk factor for many chronic diseases. It is also quite an expensive one, generating direct health service costs of approximately NIS 1.14 billion, which is equivalent to 0.16% of Israel’s Gross Domestic Product – or 2.04% of the country’s health expenditure.
Cost-utility ratios of three interventional modalities for the prevention and treatment of obesity – dietary counseling, pharmaceutical interventions and bariatric surgery – were calculated by building a model using primary Israeli data for dietary interventions, as well as by converting results from the published literature to the epidemiological and economic conditions in Israel.
Generally, the ratios were found to be very favorable: the majority were either cost-saving or very cost-effective. Cost-saving interventions are those that actually reduce costs overall, as the treatment costs averted by the decrease in morbidity exceed the cost of the intervention. Very cost-effective interventions are those that achieve an increase in quality-adjusted life years (QALYs) at a relatively low cost (the cost per QALY is less than the per capita GNP, in keeping with the accepted WHO criteria).
Dietary counseling was either cost-saving or very cost-effective, while pharmaceutical interventions were either very cost-effective or cost-effective. The various surgical interventions ranged from being cost-saving to cost-effective, contingent upon the specific technique and the study. In general, these three modalities incrementally address populations that are increasingly more obese or difficult to treat. As such, they do not compete with one another. Differences in cost-effectiveness exist within each treatment modality, but the data are not robust enough to facilitate within-modality prioritization at this point.
This report confirms the cost-effectiveness of several interventions already funded to some degree in the basket of health services. These include dietary counseling for the obese or severely overweight. Surgical interventions are only funded for those with Class III obesity or Class II obesity with risk factors. On the other hand, pharmaceutical interventions, such as sibutramine and orlistat are not funded, but as they too have been shown to be very cost-effective, they too should be considered for funding.