DMSO: Evaluating the Cost-Effectiveness of Bariatric Surgery in Tunisia

Obesity has become a major health problem worldwide and is considered a leading cause of morbidity and mortality. In Tunisia, the prevalence of obesity has increased dramatically in recent years, and it is estimated that over 30% of the population is overweight or obese. Bariatric surgery has emerged as an effective treatment option for obesity, but it is often seen as expensive and inaccessible in developing countries like Tunisia. This article explores the cost-effectiveness of bariatric surgery in Tunisia, evaluating its potential impact on the health and economic outcomes of the country. We will examine the benefits and risks of bariatric surgery, the cost of the procedure, and the long-term results of the surgery to determine if it is a worthwhile investment.


Obesity is a major global issue that is impacting countries at all income levels, including Tunisia. The prevalence of obesity in Tunisia has been increasing, and the condition is associated with a range of adverse health outcomes, including reduced quality of life, increased morbidity and mortality, and significant economic burden. Bariatric surgery has been shown to be an effective intervention in managing obesity, resulting in improved clinical outcomes, as well as intrinsic health and well-being benefits for patients. Despite evidence of the clinical benefits of bariatric surgery, the cost-effectiveness of this intervention in Tunisia has not been widely studied.

To address this gap in knowledge, a study was undertaken to examine the cost-effectiveness of bariatric surgery in Tunisia from the perspective of the healthcare payor. The study used a Markov model to compare the lifetime costs and outcomes of bariatric surgery with conventional treatment in patients with body mass index (BMI) greater than or equal to 40 kg/m2, or BMI greater than or equal to 35 kg/m2 with obesity-related co-morbidities (Group 1), or BMI greater than or equal to 35 kg/m2 with type 2 diabetes mellitus (T2DM) (Group 2). Inputs were sourced from the Tunisian Health Examination Survey, local clinician data, and literature sources. Health states were associated with different cost and utility decrements, and changes in BMI, systolic blood pressure, lipid ratio, and diabetes remission rates were modelled on a yearly basis.

The study found that bariatric surgery was cost-effective for patients with obesity and those with T2DM and obesity-related comorbidities, with an incremental cost-effectiveness ratio (ICER) of 1844 TND/QALY in Group 1 patients and 2413 TND/QALY in Group 2 patients. Bariatric surgery resulted in a QALY gain of 3.26 per patient in Group 1 and a gain of 1.77 per patient in Group 2. The study’s findings suggest that bariatric surgery can result in significant economic benefits for Tunisia, with potential implications for future decision-making on funding and reimbursement of bariatric surgery.

The study’s results are consistent with the findings of previous studies that have examined the cost-effectiveness of bariatric surgery in other countries. However, the study is the first of its kind in Tunisia, highlighting the need for further research on the cost-effectiveness of bariatric surgery in different contexts. The study’s findings underscore the importance of addressing obesity as a public health priority, and the potential benefits of investing in comprehensive obesity management programs that encompass a range of interventions, including lifestyle modification, pharmacotherapy, and bariatric surgery. Overall, the study contributes to the growing body of evidence on the value of bariatric surgery in the management of obesity and related comorbidities, and provides important insights into the cost-effectiveness of this intervention in Tunisia, a country where obesity is a significant public health concern.


In conclusion, the cost-effectiveness of bariatric surgery in Tunisia is still a topic that requires further research and analysis. While the initial cost of the procedure may seem high, the long-term benefits in terms of improved health, increased productivity, and reduced healthcare costs cannot be ignored. Additionally, the availability of state-of-the-art facilities and highly skilled surgeons in Tunisia make it an attractive destination for medical tourism, particularly for individuals seeking affordable bariatric surgery options. It is important for policymakers and healthcare providers in Tunisia and beyond to consider the cost-effectiveness of bariatric surgery as a viable solution for addressing the obesity epidemic and promoting overall public health.