A 10-Year Cost-Effectiveness Analysis of Metabolic and Bariatric Surgery in Adolescents

Importance: Obesity affects 1 in 5 US children, with the global prevalence projected to double by 2035. Among adolescents with severe obesity, metabolic and bariatric surgery (MBS) yields durable weight loss and comorbidity improvement, although its long-term cost-effectiveness remains uncertain. Objective: To evaluate the 10-year cost-effectiveness of MBS for adolescents with severe obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. Design, Setting, and Participants: This economic evaluation used a microsimulation model of a cohort of 100 000 simulated adolescents in the US health care sector to project health and cost outcomes of no surgery, Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy over 10 years among adolescents with severe obesity. Model inputs, including longitudinal clinical performance, were derived from Teen-LABS study data, published literature, and national databases. Data were analyzed from April 2023 to October 2025. Main Outcomes and Measures: Quality-adjusted life-years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted at 3.0% annually. A willingness-to-pay (WTP) threshold of $100 000 per QALY gained was used to assess cost-effectiveness. Results: The population was a hypothetical cohort of 100 000 adolescents with the following baseline characteristics: age 17 years, body mass index 52.1, 75.0% female, 13.3% with type 2 diabetes, 4.9% with low ferritin, 37.2% with low vitamin D, and 0.4% with low vitamin B12. At 10 years, sleeve gastrectomy was projected to be the cost-effective strategy, with an ICER of $41 164 per QALY gained when compared with no surgery. RYGB yielded the most QALYs, although with a less favorable ICER of $557 751 per QALY gained compared with sleeve gastrectomy. However, in a direct comparison with no surgery, RYGB was estimated to be cost-effective, with an ICER of $50 271 per QALY gained. In sensitivity analyses, sleeve gastrectomy was consistently the cost-effective strategy. Conclusions and Relevance: In this economic evaluation of bariatric surgery for adolescents with severe obesity, both RYGB and sleeve gastrectomy were determined to be cost-effective when compared with no surgery. However, sleeve gastrectomy was estimated to be the cost-effective strategy over a 10-year time horizon when simultaneously comparing all 3 interventions. These findings complement established clinical evidence of the long-term benefits of MBS, supporting its economic value.