Future research
comorbidity, weight loss
COMPLICATIONS
Future research that could validate our findings and reduce uncertainty in our estimates include longer-term randomised studies of ESG from which BMI-based health state transition probabilities, comorbidity rates, and potentially even mortality could be estimated to use directly in the model or to validate values derived from the literature. Randomised studies evaluating the impact of ESG-induced weight loss on health-related quality of life with a larger set of observations than were captured in MERIT and a cost/resource use study that could provide a more precise estimate of long-term costs associated with ESG and LM would also bring additional certainty to our findings.Distributional effects were not formally evaluated in our model, though availability of ESG which can routinely be performed as a day case procedure could potentially help to improve efficiency in NHS service delivery and reduce health inequalities. Well conducted studies providing evidence on comparative effectiveness/safety (including risk of post-procedural complications), impact on health-related quality of life, and costs/resource use (e.g., length of inpatient stay) are needed to inform robust economic evaluations of ESG versus other bariatric procedures. Given common patient concerns about risks/complications associated with surgery, incorporation of patient preferences into any such economic evaluation will also be important.