OBJECTIVES: Bariatric surgery (BS), an effective treatment for morbid obesity, is proven to reduce comorbidities. However, in absence of health economics studies in India, surgeons and patients/payers are uncertain about the long term economic implications of BS. This study aimed to evaluate and compare the cumulative healthcare cost incurred by morbidly obese patients opting for BS with those incurred by patients opting for conventional treatment over a 10-year period in India. METHODS: A cost comparison model was developed using a combination of a decision tree and a Markov model. Two types of surgeries common in India – laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, were considered in the BS arm. Transition probabilities and BS related outcomes data were sourced from published literature. The analysis considered direct medical costs including the cost of bariatric surgery and associated complications, cost of drugs, physician visits and hospitalization for managing co-morbidities, and cost of obesity management measures. All costs were discounted at 3%. The results were expressed in terms of difference in total per-patient healthcare costs incurred by patients in the two arms. RESULTS: For a hypothetical population with a mean age of 40 years and a mean BMI of 43 kg/m, the total per-patient cost for BS arm was ₹688k compared to ₹1,015k for the conventional arm over a period of 10 years. Per patient co-morbidity management cost, over 10 years, in the BS arm is only ~30% of that in conventional arm. The current analysis estimated that initial investment in BS will be recouped in less than 6 years post-surgery due to cost saving in co-morbidity management. CONCLUSIONS: The current analysis shows that although bariatric surgery requires an initial investment, it will result in lower healthcare expenses compared to conventional treatment, in a five year time period after surgery.