Cost-effectiveness of endoscopic treatments for obesity: a clinical evidence map and systematic review to inform a model-based cost-effectiveness analysis
Albon, Esther Afentou, Nafsika Dretzke, Janine Hall, James Ogwulu, Chidubem Okeke Price, Malcolm J Clare, Ken Singhal, Rishi Tahrani, Abd Frew, Emma
Albon, Esther
Afentou, Nafsika
Dretzke, Janine
Hall, James
Ogwulu, Chidubem Okeke
Price, Malcolm J
Clare, Ken
Singhal, Rishi
Tahrani, Abd
Frew, Emma
Affiliation
University of Birmingham; Obesity UK; University Hospitals Birmingham NHS Foundation Trust
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Publication date
2025-12
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Abstract
Background: Bariatric surgery is the most effective treatment for obesity, but access is limited. Endoscopic obesity treatments are potentially cheaper and less invasive options, which may be similarly effective. There is currently a lack of evidence to inform decisions on whether such treatments should be considered for people living with obesity.
Objective(s): What is the current evidence for the clinical and cost-effectiveness of endoscopic treatments compared to alternative weight management interventions for obesity?
Methods: Comprehensive searches were undertaken to January 2023 and a searchable evidence map of all quantitative studies (n > 2) on endoscopic treatments was constructed. The map was used where possible to inform the economic models. Indirect comparisons were undertaken where relevant direct evidence for the model was not available. A systematic review of cost-effectiveness studies was undertaken. Targeted searches were undertaken to identify additional evidence to inform model parameters. Three economic (Markov) models were designed to estimate the cost-effectiveness of endoscopic therapies compared to alternative weight management interventions from a United Kingdom National Health Service and Personal Social Services perspective.
Results: The evidence map included over 1500 records of studies of endoscopic therapies, most of which related to intragastric balloons and endoscopic sleeve gastrectomy. Three cost-utility analyses were identified, one of which was set in the United Kingdom and was used to inform the models. Laparoscopic sleeve gastrectomy is likely cost-effective compared with endoscopic sleeve gastroplasty for patients' obesity class II and III (£10,593 per quality-adjusted life-year-gained). Endoscopic sleeve gastroplasty is likely cost-effective compared with semaglutide for patients' obesity class I and II (£7267 per quality-adjusted life-year-gained). Semaglutide is dominant (cheaper and more effective) than intragastric balloon in patients' obesity class I and II. Probabilistic sensitivity analysis found a degree of confidence in the estimates. The 5-year time horizon may not capture longer-term benefits from endoscopic sleeve gastroplasty or laparoscopic sleeve gastrectomy.
Limitations and conclusions: The effectiveness evidence base was greater and more wide-ranging than anticipated. However, for the interventions compared within the economic models, there were no randomised controlled trials and either limited, or an absence of, direct comparative evidence. There was also limited long-term data on interventions. These limitations necessitated the use of assumptions in modelling.
Future work: Future research should focus on longer-term effectiveness of endoscopic treatments, studies directly comparing endoscopic therapies against semaglutide or other emerging weight loss drugs and studies which better reflect the complex treatment pathways of obesity and different obesity classes. Such studies could provide more robust evidence for informing future cost-effectiveness models beyond a 5-year time horizon.
Plain language summary
Treating obesity can improve the health and quality of life of people living with obesity and reduce the burden of obesity-associated medical problems. It also has wide-ranging economic benefits. Bariatric (weight loss) surgery remains the most effective long-term treatment and is good value for money for the United Kingdom healthcare system. However, there are barriers to accessing this surgery including a lack of resources and variability in service availability. Endoscopy is a non-surgical procedure that uses a flexible tube (an endoscope) passed through the mouth to look at the digestive tract. Small tools located at the end of the endoscope can be used to help weight loss by changing the size or shape of the stomach or by inserting a liner or balloon. Endoscopic weight loss therapies may be cheaper, more acceptable alternatives as they are less invasive and need a shorter hospital stay. We undertook a wide-ranging systematic search of the published literature and identified a large number of articles (1574) looking at endoscopic therapies. We also identified many different types of endoscopic therapies. We have produced an extensive list of these studies to aid future understanding of the effects of these therapies. There were limited studies on the value for money of endoscopic therapies. Therefore, we built three models to compare the cost-effectiveness between treatments over 5 years. These models found that laparoscopic sleeve gastrectomy (a bariatric surgery procedure) is likely to be better value for money than endoscopic sleeve gastroplasty (an endoscopic approach to reducing stomach size). Endoscopic sleeve gastroplasty is likely to be better value for money than semaglutide (a weight loss drug). Semaglutide is likely to be better value for money than a gastric balloon placed via endoscopy. This suggests that both endoscopic sleeve gastroplasty and semaglutide are feasible options for weight loss. The choice may depend on the stage a patient is at in their weight loss journey and their preference. Despite the findings of the models, it is important to realise that the data did not originate from high-quality studies directly comparing these therapies and some assumptions on how effective the therapies would be over long periods of time had to be used. Future studies should directly compare the therapies, follow patients for longer and consider that some patients receive multiple treatments for obesity over time.
Citation
Albon E, Afentou N, Dretzke J, Hall J, Ogwulu CO, Price MJ, Clare K, Singhal R, Tahrani A, Frew E, Moore DJ. Cost-effectiveness of endoscopic treatments for obesity: a clinical evidence map and systematic review to inform a model-based cost-effectiveness analysis. Health Technol Assess. 2025 Dec;29(68):1-196. doi: 10.3310/PWKQ2310.
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Article