Cost–Utility Analysis of Gastric Bypass for Severely Obese Patients in Spain

Castilla, Iván; Mar, Javier; Valcárcel-Nazco, Cristina; Arrospide, Arantzazu; Ramos-Goñi, Juan Manuel

doi:10.1007/s11695-014-1304-0

Cited by 23 publications

(42 citation statements)

References 39 publications

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“…Utilities are assessed relative to a 0.00–1.00 scale, where 1.00 represents perfect health and 0.00 represents death, and therefore indicates the strength of preference for quality versus quantity of life [ 29 ]. Utilities are also a vital component of cost-utility analysis (a commonly used form of full economic evaluation that assesses the incremental costs of an intervention versus the incremental gains in quality-adjusted life-years) [ 12 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners

Campbell

Hensher²,

Neil

et al. 2017

PharmacoEconomics Open

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BackgroundLong-term publicly waitlisted bariatric surgery patients typically experience debilitating physical/psychosocial obesity-related comorbidities that profoundly affect their quality of life.ObjectivesWe sought to measure quality-of-life impacts in a study population of severely obese patients who had multiyear waitlist times and then underwent bariatric surgery.MethodsParticipants were recruited opportunistically following a government-funded initiative to provide bariatric surgery to morbidly obese long-term waitlisted patients. Participants self-completed the EQ-5D-5L and AQoL-8D questionnaires pre- and postoperatively. Utility valuations (utilities) and individual/super dimension scores (AQoL-8D only) were generated.ResultsParticipants’ (n = 23) waitlisted time was mean [standard deviation (SD)] 6.5 (2) years, body mass index reduced from 49.3 (9.35) kg/m2 preoperatively to 40.8 (7.01) 1 year postoperatively (p = 0.02). One year utilities revealed clinical improvements (both instruments). AQoL-8D improved significantly from baseline to 1 year, with the change twice that of the EQ-5D-5L [EQ-5D-5L: mean (SD) 0.70 (0.25) to 0.78 (0.25); AQoL-8D: 0.51 (0.24) to 0.67 (0.23), p = 0.04], despite the AQoL-8D’s narrower algorithmic range. EQ-5D-5L utility plateaued from 3 months to 1 year. AQoL-8D 1-year utility improvements were driven by Happiness/Coping/Self-worth (p < 0.05), and the Psychosocial super dimension score almost doubled at 1 year (p < 0.05). AQoL-8D revealed a wider dispersion of individual utilities.ConclusionsOngoing improvements in psychosocial parameters from 3 months to 1 year post-surgery accounted for improvements in overall utilities measured by the AQoL-8D that were not detected by EQ-5D-5L. Selection of a sensitive instrument is important to adequately assess changes in quality of life and to accurately reflect changes in quality-adjusted life-years for cost-utility analyses and resource allocation in a public healthcare resource-constrained environment.

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Section: Introductionmentioning

confidence: 99%

An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners

Campbell

Hensher²,

Neil

et al. 2017

PharmacoEconomics Open

View full text Add to dashboard Cite

show abstract

“…A recent study that investigated the incorporation of economic evidence and perspectives in Cochrane reviews argued that questions such as ‘at what cost is the outcome achieved?’, and ‘what will be the economic impact of this intervention?’ are crucial if health systems are to use the resources they have available to their best advantage . Many full economic evaluations conclude that bariatric procedures are a cost‐effective treatment option for obesity . In contrast, a recent critique opined that accumulating evidence suggested no economic benefit for bariatric surgery .…”

Section: Introductionmentioning

confidence: 99%

Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review

et al. 2016

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There is a need for studies that assume a broader societal perspective (including out-of-pocket costs, costs to family and productivity losses) and longer-term costs (capture reoperations/complications, waiting, body contouring), and consequences (health-related quality-of-life). Full economic evaluation underpinned by reporting standards should inform prioritization of patients (e.g. type 2 diabetes mellitus with body mass index 30 to 34.9 kg/m(2) or long-term waitlisted) for surgery. © 2016 World Obesity.

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“…In contrast, Swedish and Spanish studies based on simulation models showed large long-term cost savings along with increased quality-adjusted life-years. 44,45 It should be noted, however, that many of the studies with long-term follow-up provide data on historical procedures. For example, only a small proportion of patients in the Swedish Obese Subjects study 21 underwent laparoscopic RYGB; the majority underwent a restrictive procedure (gastric band or vertical banded gastroplasty).…”

Section: Discussionmentioning

confidence: 99%

“…Studies from the United Kingdom tend not to show absolute cost savings, 18,19,41,43,47 whereas studies from elsewhere show mixed but generally more positive results. 20,22,44,45,48 We used a predicted relapse rate of 6% in our model. This is consistent with that reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Effect of Roux-en-Y gastric bypass on pharmacologic dependence in obese patients with type 2 diabetes

Sharples

Mullan

Hardy

et al. 2019

cjs

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Background: More than half the diabetes-related health care costs in Canada relate to drug costs. We aimed to determine the effect of Roux-en-Y gastric bypass (RYGB) on the use of insulin and orally administered hypoglycemic medications in patients with diabetes. We also looked to determine overall cost savings with the procedure. Methods: We reviewed the bariatric clinic records of all patients with a confirmed diagnosis of type 2 diabetes mellitus who underwent RYGB between 2010/11 and 2014/15. Percentage estimated weight loss was recorded at 1 year, along with reductions in glycated hemoglobin (HbA 1c) level and use of oral hypoglycemic therapy and insulin. We estimated medication costs using Manitoba-specific pricing data. Results: Fifty-two patients with at least 12 months of complete follow-up data were identified. The mean percentage estimated weight loss was 50.2%. The mean HbA 1c level decreased from 7.6% to 6.0%, the mean number of orally administered hypoglycemics declined from 1.6 to 0.2, and the number of patients receiving insulin decreased from 18 (35%) to 3 (6%) (all p < 0.001). The rate of resolution of type 2 diabetes was 71%.

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Cost–Utility Analysis of Gastric Bypass for Severely Obese Patients in Spain

Abstract: Gastric bypass is an intervention that dominates over the option of not intervening when a lifetime horizon is considered.

Cited by 23 publications

References 39 publications

An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners

An Exploratory Study of Long-Term Publicly Waitlisted Bariatric Surgery Patients’ Quality of Life Before and 1 Year After Bariatric Surgery, and Considerations for Healthcare Planners

Diverse approaches to the health economic evaluation of bariatric surgery: a comprehensive systematic review

Effect of Roux-en-Y gastric bypass on pharmacologic dependence in obese patients with type 2 diabetes

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