Cost-Effectiveness of Bariatric Surgery in Adolescents With Severe Obesity: 10-Year Economic Evaluation of Sleeve Gastrectomy vs Gastric Bypass

Severe obesity in adolescents has become one of the most pressing public health and economic challenges globally. A recent economic evaluation published in JAMA Network Open (2026) examined whether metabolic and bariatric surgery (MBS), specifically sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB), is cost-effective over a 10-year period for adolescents with severe obesity.

The findings suggest that both surgical options provide meaningful long-term health benefits and are economically reasonable compared with non-surgical care. Among the two procedures, sleeve gastrectomy generally emerged as the most cost-effective strategy over the modeled time horizon.

This blog provides summary of a study, its methods, findings, and policy implications.

Background: Rising Rates of Severe Obesity in Adolescents

The study begins by highlighting a significant rise in pediatric and adolescent obesity. Severe obesity, including class 2 and class 3 categories, has increased sharply over the past decade. Even more concerning, extremely severe obesity has seen exponential growth.

These trends are clinically important because severe obesity in adolescence is strongly linked to early development of conditions such as:

• Type 2 diabetes
• Hypertension
• Dyslipidemia
• Long-term cardiovascular disease

In addition to health consequences, the financial burden is substantial. Annual direct healthcare costs linked to pediatric obesity exceed billions of dollars in the United States alone.

While lifestyle modification remains the first-line treatment, its long-term effectiveness in severe cases is limited. This has led to increased interest in bariatric surgery for adolescents who meet clinical criteria.

Study Objective and Design

The primary goal of the study was to evaluate whether bariatric surgery is cost-effective over a 10-year period for adolescents with severe obesity.

Researchers used a microsimulation model involving 100,000 simulated adolescents in the United States. The cohort had a baseline age of 17 years and an average body mass index (BMI) of 52.1, reflecting a severely obese population.

Three treatment strategies were compared:

1. No surgery
2. Sleeve gastrectomy
3. Roux-en-Y gastric bypass (RYGB)

The model incorporated data from the Teen-LABS study, national health databases, and published clinical literature. Key outcomes included:

• Quality-adjusted life-years (QALYs)
• Total healthcare costs
• Incremental cost-effectiveness ratios (ICERs)

A willingness-to-pay threshold of $100,000 per QALY was used to determine cost-effectiveness.

Key Findings: Cost and Effectiveness Results

Overall Economic Outcomes

At the 10-year mark, both surgical options were more effective than no surgery in improving quality of life and health outcomes.

• No surgery: Lowest cost but also lowest health benefit
• Sleeve gastrectomy: Balanced cost and strong effectiveness
• RYGB: Highest health gains but also highest cost

Cost-Effectiveness Results

• Sleeve gastrectomy had an ICER of approximately $41,164 per QALY gained vs no surgery
• RYGB had an ICER of approximately $50,271 per QALY gained vs no surgery
• RYGB compared directly to sleeve gastrectomy was not cost-effective, with an ICER exceeding $557,000 per QALY

These results indicate that while both surgeries are economically reasonable compared with non-surgical management, sleeve gastrectomy provides better value within the 10-year horizon.

Health Outcomes and Clinical Effects

Both surgical procedures produced substantial improvements in health outcomes:

• Significant BMI reduction over 10 years
• Improved remission rates of type 2 diabetes
• Enhanced quality of life

RYGB showed slightly greater QALY gains, but also came with higher risks of complications and micronutrient deficiencies.

Micronutrient deficiencies observed included:

• Low ferritin in over 40% of surgical patients
• Vitamin D deficiency in nearly half of patients
• Vitamin B12 deficiency more common after RYGB

Despite these risks, overall health gains outweighed adverse effects in the model.

Sensitivity Analysis: Testing the Robustness of Results

The researchers performed sensitivity analyses to test how changes in assumptions affected outcomes. The results showed that:

• The model was most sensitive to BMI reduction and quality-of-life improvements
• Sleeve gastrectomy remained the preferred strategy in most scenarios
• RYGB became more favorable only under specific conditions, such as reduced complication rates or improved cost profile

Probabilistic simulations confirmed that sleeve gastrectomy was the most cost-effective option in approximately 58% of iterations.

Interpretation: What These Results Mean for Healthcare

This analysis supports the idea that bariatric surgery is not only clinically effective but also economically justified in adolescents with severe obesity.

Key implications include:

• Bariatric surgery provides long-term value compared with non-surgical care
• Sleeve gastrectomy may be the most efficient option in most healthcare settings
• Early intervention in severe adolescent obesity may reduce long-term healthcare costs

These findings are especially relevant for policymakers, insurers, and healthcare providers considering coverage decisions for adolescent bariatric surgery.

Comparison With Previous Research

Previous studies in adults have consistently shown bariatric surgery to be cost-effective over time. However, adolescent-specific data have been limited.

Earlier models often relied on short-term or extrapolated data. In contrast, this study strengthens the evidence base by using long-term prospective data from Teen-LABS and avoiding heavy extrapolation.

This makes the findings more reliable for real-world adolescent populations with severe obesity.

Limitations of the Study

The authors acknowledge several limitations:

• BMI progression in non-surgical patients may be underestimated over time
• Some complication rates were derived from adult populations due to limited adolescent data
• Type 2 diabetes relapse after remission was not included
• Model assumptions may not capture all long-term real-world variability

Despite these limitations, the direction of results consistently favored surgical intervention, suggesting robust conclusions.

Conclusion: Economic Value of Bariatric Surgery in Adolescents

The 10-year economic evaluation demonstrates that both sleeve gastrectomy and Roux-en-Y gastric bypass are cost-effective treatment options for adolescents with severe obesity when compared to non-surgical care.

Among the two, sleeve gastrectomy appears to offer the most favorable balance of cost and effectiveness over a 10-year period. These findings reinforce the growing clinical consensus that metabolic and bariatric surgery should be considered a key treatment option for appropriately selected adolescents with severe obesity.

As healthcare systems continue to address rising obesity rates, these results provide important evidence to support informed policy decisions and broader access to surgical treatment when clinically indicated.

Source: JAMA Network Open, Vol. 9, Issue 6, June 2026, “A 10-Year Cost-Effectiveness Analysis of Metabolic and Bariatric Surgery in Adolescents.”

Disclaimer:
This blog is a written summary of a peer-reviewed economic evaluation published in JAMA Network Open (2026). It is intended for informational purposes only and should not be used as a substitute for professional medical advice or clinical decision-making.