An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners
Campbell, JA, Hensher, Martin, Neil, A, Venn, A, Wilkinson, S and Palmer, AJ 2018, An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners, PharmacoEconomics - Open, vol. 2, no. 1, pp. 63-76, doi: 10.1007/s41669-017-0038-z.
An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners
Background: Long-term publicly waitlisted bariatric surgery patients typically experience debilitating physical/psychosocial obesity-related comorbidities that profoundly affect their quality of life. Objectives: We sought to measure quality-of-life impacts in a study population of severely obese patients who had multiyear waitlist times and then underwent bariatric surgery. Methods: Participants were recruited opportunistically following a government-funded initiative to provide bariatric surgery to morbidly obese long-term waitlisted patients. Participants self-completed the EQ-5D-5L and AQoL-8D questionnaires pre- and postoperatively. Utility valuations (utilities) and individual/super dimension scores (AQoL-8D only) were generated. Results: Participants’ (n = 23) waitlisted time was mean [standard deviation (SD)] 6.5 (2) years, body mass index reduced from 49.3 (9.35) kg/m2 preoperatively to 40.8 (7.01) 1 year postoperatively (p = 0.02). One year utilities revealed clinical improvements (both instruments). AQoL-8D improved significantly from baseline to 1 year, with the change twice that of the EQ-5D-5L [EQ-5D-5L: mean (SD) 0.70 (0.25) to 0.78 (0.25); AQoL-8D: 0.51 (0.24) to 0.67 (0.23), p = 0.04], despite the AQoL-8D’s narrower algorithmic range. EQ-5D-5L utility plateaued from 3 months to 1 year. AQoL-8D 1-year utility improvements were driven by Happiness/Coping/Self-worth (p < 0.05), and the Psychosocial super dimension score almost doubled at 1 year (p < 0.05). AQoL-8D revealed a wider dispersion of individual utilities. Conclusions: Ongoing improvements in psychosocial parameters from 3 months to 1 year post-surgery accounted for improvements in overall utilities measured by the AQoL-8D that were not detected by EQ-5D-5L. Selection of a sensitive instrument is important to adequately assess changes in quality of life and to accurately reflect changes in quality-adjusted life-years for cost-utility analyses and resource allocation in a public healthcare resource-constrained environment.
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