Cost-Effectiveness of Bariatric Surgery versus Medication Therapy for Obese Patients with Type 2 Diabetes in China: A Markov Analysis

Abstract

Aims/Introduction. The present study estimated the cost-effectiveness of bariatric surgery versus medication therapy for the management of recently diagnosed type 2 diabetes mellitus (T2DM) in obese patients from a Chinese health insurance payer perspective. Materials and Methods. A Markov model was established to compare the 40-year time costs and quality-adjusted life-years (QALYs) between bariatric surgery and medication therapy. The health-care costs in the bariatric surgery group, proportion of patients in each group with remission of diabetes, and state transition probabilities were calculated based on observed resource utilization from the hospital information system (HIS). The corresponding costs in the medication therapy group were derived from the medical insurance database. QALYs were estimated from previous literature. Costs and outcomes were discounted 5% annually. Results. In the base case analysis, bariatric surgery was more effective and less costly than medication therapy. Over a 40-year time horizon, the mean discounted costs were 86,366.55 RMB per surgical therapy patient and 113,235.94 CNY per medication therapy patient. The surgical and medication therapy patients lived 13.46 and 10.95 discounted QALYs, respectively. Bariatric surgery was associated with a mean health-care savings of 26,869.39 CNY and 2.51 additional QALYs per patient compared to medication therapy. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses, and the results were robust. Conclusions. Bariatric surgery is a dominant intervention over a 40-year time horizon, which leads to significant cost savings to the health insurance payer and increases in health benefits for the management of recently diagnosed T2DM in obese patients in China.

Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations

“…Thirty original articles from 33 publications fulfilled the inclusion criteria. Of these, 16 reported on the cost-effectiveness of metabolic surgery specifically in a T2D population [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], including two empirical studybased economic evaluations [34,40]. Seventeen publications reported on the cost-effectiveness of metabolic surgery in a population with obesity in which a subgroup of the population had T2D [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”

“…Fifteen studies were conducted in European countries [27, 28, 36-38, 43-47, 50, 52, 55, 58, 59], four in the USA [31,32,35,56], three in South America [29,30,49], four in Asia [39][40][41][42], three in Australia [33,34,53], and one in Canada [54].…”

Metabolic surgery in China: present and future

“…RYGB is therefore cost-effective for Chinese patients with T2DM and obesity at 4 years after surgery ( Tu et al, 2019 ). Two other studies also support that, compared with drug treatment of patients with obesity and T2DM, metabolic surgery can bring long-term economic savings ( Tang et al, 2016 ; Wan et al, 2019 ), with more savings from SG ( Tang et al, 2016 ). Wu et al (2021) found that metabolic surgery in patients with obesity and T2DM is expensive, but leads to an improved comorbidity profile, and reduced length of hospitalization.…”

Pharmacoeconomics of obesity in China: a scoping review

“…A careful search on Google Scholar of articles on pharmacoeconomic analysis on obesity in China (search keywords: pharmacoeconomic AND obesity AND China) published during 2010-2020 yielded 4,250 hits, but only five studies were identified by two of the co-authors as relevant, with obesity as the primary condition studied and China as the study setting [6,[39][40][41][42].…”

“…health insurance payer and increases in health benefits (2.51 QALY) in a 40-year time horizon, compared to medication therapy[41].…”