Cost‐Effectiveness of Surgical Weight‐Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity

The usual care plus Roux-en-Y gastric bypass (RYGB) strategy increased quality-adjusted life expectancy by 1.35 years compared to usual care alone.

• Usual care plus RYGB increased lifetime costs by $7,209 compared to usual care alone, with an incremental cost-effectiveness ratio (ICER) of $5,300 per quality-adjusted life year (QALY).
• Both usual care plus RYGB and usual care plus laparoscopic sleeve gastrectomy (LSG) reduced opioid use from 13% to 4%.
• Total knee replacement (TKR) usage increased from 30% to 50% with usual care plus RYGB, and to 41% with usual care plus LSG.
• In cohorts with BMI between 38 and 41 kg/m, usual care plus LSG was more effective than usual care plus RYGB.
• At a willingness-to-pay threshold of $50,000 per QALY, usual care plus RYGB was cost-effective in 70% of simulations, while usual care plus LSG was cost-effective in 30% of simulations.

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