الفهرس 
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Abstract
Health economics is about adoption of the option that achieves maximum value
(effective outcome) with the with the least possible cost. Through cost-effectiveness
analysis, decision makers both at the national or individual level can develop healthcare
related decisions that support the implementation of a cost-effective option that is, the
option which achieves the maximum value from the available resources.
Over the past decades an evolution of cost-effectiveness importance recognition as a
valuable evaluation tool in healthcare has taken place. In the mid 1990s, this evolving
importance triggered development of consensus-based recommendations for costeffectiveness
analyses implementation in healthcare. Many researchers used costeffectiveness
as a valuable tool in assessing healthcare programs and treatment alternatives
all over healthcare aspects and domains.
As a developing county, Egypt faces many economic challenges. This has been
markedly complicated by the political and economic instability since the uprising in 2011.
Obesity is a pathological condition that refers to accumulation of excess body fat that
may cause several adverse effects on health leading to decreased life expectancy. It is
commonly defined by a measurement of Body Mass Index (BMI). BMI is calculated by
dividing body weight (kilograms) by height (meters squared). Obesity in adults is most
commonly defined as a BMI of 30 kg/m2 or more while morbid obesity is defined as a
BMI of 40 kg/m2 or more.
Obesity represents a problem with a huge burden on both individuals and societies. It
is an increasing problem worldwide. In Egypt 12.7% of males below 20 years were obese
compared to 14.4% of females in the same age group while for those above 20 years,
26.4% of males and 48.4% of females were obese.
Management of obesity as a chronic healthcare problem usually follows a stepped
management approach. It starts by broad lifestyle modification passing through addition of
pharmacotherapy as an adjunctive option. Finally, bariatric surgery comes as a third option
for more severe cases indicated for that option.
Egypt is currently facing low income, increased public debt, and decreased currency
value. This renders concepts as cost-effectiveness quite essential. On the other hand, rising
rates of obesity in developing countries like Egypt has an association with cheaper prices
of high calorie foods. This could be one of the main reason for obesity being a complicated
problem in Egypt.
Although obesity reached very high levels in Egypt, the urgent need for research on
cost-effectiveness studies conducted in the context of obesity treatment options evaluation
has been far from fulfilled.
The aim of this work is to compare the cost-effectiveness of laparoscopic sleeve
gastrectomy versus Orlistat based regimen in treatment of morbidly obese patients
attending University Hospitals – Alexandria – Egypt.
Summary
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The study design included both a cross sectional approach employing the Delphi
technique by surveying a panel of experts, and a retrospective approach by reviewing
medical records of a number of morbidly obese patients who underwent Laparoscopic
Sleeve Gastrectomy (LSG) regarding cost and effectiveness.
The Delphi panel methodology consists of consensus consultations. The Delphi
methodology is based on conducting structured surveys and makes use of the intuitive
available information of the participants who are mainly specialists in the field.
For assessing both cost and effectiveness of Orlistat-based regimen, we surveyed a panel
of four out of a total of five experts included in the weekly schedule in the therapeutic nutrition
clinic in the High Institute of Public Health (HIPH), Alexandria University.
In the Medical Research Institute hospital in 2015 we found that, on average, LSG
cost EGP 25,839 and resulted in a reduction of 14.7 Kg/m2 in BMI (ACER=1,758
EGP/Kg/m2) while OBR cost EGP 10,777 and resulted in a reduction of 5.6 Kg/m2 in BMI
(ACER=1,924 EGP/Kg/m2). LSG was more costly but more effective. The average ICER
was 1,736 EGP/Kg/m2 ranging from 852 EGP/Kg/m2 to 17,653 EGP/Kg/m2 towards LSG
more than Orlistat-based regimen (OBR).
This research does represent important steps forward in assessing the cost-effectiveness
of two morbid obesity management options. It serves as a valuable decision-making tool on
both individual and society level to take actions towards morbid obesity management