Background and purpose of reviewThe procedures considered in the review include: adjustable gastric banding; vertical banded gastroplasty; sleeve gastrectomy; Roux-en-Y gastric bypass; and, biliopancreatic diversion with or without duodenal switch. Non-surgical interventions were deemed out of scope and only procedures currently practised in Australia are included. A diagram with details of each type of surgery is included in the report and reproduced below.
The review was carried out by Deloitte Access Economics with the support of a clinical working group (CWG). The role of the CWG was to provide clinical input to the consultants, to ensure the review reflects current clinical practice in Australia and draws valid conclusions from the evidence. The Department would like to thank the CWG members for the vital assistance provided in undertaking this review. The CWG consists of specialists nominated by:
- Obesity Surgery Society of Australia and New Zealand; and
- Royal Australasian College of Physicians.
Obesity is a disease in which fat has accumulated to the point where health is impaired, defined here in terms of Body Mass Index (BMI) over 30 for adults and a set of age-gender specific BMI thresholds for children and adolescents aged 2 to 18 years.
Clinically severe obesity is a condition generally defined as BMI ≥ 40 or between 35 and 40 where there are other major medical conditions such as high blood pressure and diabetes. It should be noted that BMI values in different populations may not correspond to the same degree of percentage of body fat or body fat distribution. As a consequence, in some ethnic groups, health risks are higher at BMIs lower than the existing defined BMI cut-off points.
The research questions addressed by the review were as follows:
- What is the safety of LAGB, VBG, SG and RYGB compared to non-surgical treatment of obesity?
- What is the safety of VBG, SG and RYGB compared to LAGB in the treatment of obesity?
- What is the effectiveness of LAGB, VBG, SG and RYGB compared to non-surgical treatment of obesity?
- What is the effectiveness of VBG, SG and RYGB compared to LAGB in the treatment of obesity?
- What is the safety of each intervention compared to other relevant comparators in the treatment of obesity?
- What is the effectiveness of each intervention compared to other relevant comparators in the treatment of obesity?
- MBS items for obesity surgery should be split into separate items for each specific obesity surgery procedure.
- Consideration should also be given to splitting obesity surgery MBS items into separate items for laparoscopic and open procedures.
- The MBS items for surgical treatment of obesity should include adolescents under special conditions (e.g. where the patient is aged over 15 years (or 14 years of age, where it can be demonstrated that exceptional circumstances exist).
- The indication ‘morbid obesity’ in the current descriptors for MBS items for the surgical treatment of obesity should be replaced with ‘clinically severe obesity’ and identify the general BMI limits relating to the term.
- There should be periodic reviews of the long-term safety and efficacy of emerging surgical techniques such as sleeve gastrectomy, and the long-term efficacy and cost effectiveness of gastric banding (including an analysis of reoperation and band adjustment rates).
If the conclusions are adopted, changes may be made to clarify which MBS item should be claimed for a specific procedure and provide an indication of when obesity surgery should be used. The proposed splitting of MBS item numbers into separate obesity procedures could support clinical best practice by providing more explicit information to surgeons and patients.
The proposed splitting could also prevent the claiming of MBS benefits for future, innovative procedures until they have been assessed as safe and cost effective by the Medical Services Advisory Committee (MSAC).
Clinicians will retain the capacity and responsibility to recommend to patients the most appropriate procedure for their circumstances.
If conclusions arising from the review are accepted they will be discussed with stakeholders, including craft groups and consumers before they are implemented.
Next stepsOnce public consultation has been undertaken the Review Report will be refined, as necessary, and will then be considered by MSAC. Any item amendments arising from MSAC’s advice regarding the findings of the review will need to be considered by Government.
Types of bariatric surgery
|Surgical Procedure||MBS item*||Description of surgical procedure||Illustration of surgical procedure|
|Adjustable gastric banding (AGB)/|
Laparoscopic adjustable gastric banding (LAGB)
|30511||Is a surgical procedure in which a small silicone band is placed around the top of the stomach to produce a small pouch about the size of a thumb, thereby limiting food intake.|
|Biliopancreatic diversion (BPD) |
Biliopancreatic diversion with duodenal switch (BPD DS)
|30512||The first two segments of the small intestine, the duodenum and jejunum, are bypassed and the stomach pouch is attached to the ileum. |
BPD in conjunction with DS is an additional adaptation where a proportion of the duodenum remains attached to the stomach.
|Roux-en-Y gastric bypass (RYGB)||30512||A small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine).|
|Sleeve gastrectomy (SG) |
Also known as: gastric sleeve, tube gastrectomy
|Various MBS items 30511 or 30518||Is the first component of the duodenal switch operation and involves removing the lateral 2/3rds of the stomach with a stapling device. It leaves a stomach tube instead of a stomach sack.|
|Vertical banded gastroplasty (VBG)|
Also known as: stomach stapling
|30511||The upper stomach near the oesophagus is stapled vertically to create a small pouch along the inner curve of the stomach. The outlet from the pouch to the rest of the stomach is restricted by a band.|
Review ProtocolThe draft review protocol for surgical interventions for the treatment of obesity underwent a three week public consultation period, which closed on 16 November 2010. The submissions have been considered and the final review protocol is available below.
Review protocol - Obesity (PDF 791 KB)
Review Protocol - Obesity (Word 2,355 KB)
Draft Review ReportThe draft report on the review of MBS items for the surgical treatment of obesity was released on 1 June 2011 and responses on the report will be accepted until the close of business on the 28 June 2011. The report is available below.
Draft Obesity Report (PDF 1,276 KB)
Draft Obesity Report (Word 4,051 KB)
Report Response ProformaA proforma for responding to the review report is available below. Completed forms should be returned electronically to MBRTG@health.gov.au or mailed to
Review of Obesity Surgery
Department of Health and Ageing
Medical Benefits Reviews Task Group (MDP 950)
PO Box 9848
CANBERRA ACT 2601
Responses received before the close of business on 28 June 2011 are guaranteed to be considered in preparation of final advice to Government.
The response proforma is below:
Response proforma - Obesity (PDF 46 KB)
Response Proforma - Obesity (Word 355 KB)