Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes

Abstract

IMPORTANCE Bariatric surgery is recommended for patients with severe obesity (body mass index Ն40) and type 2 diabetes (T2D). However, the most cost-effective treatment remains unclear and may depend on the patient's T2D severity. OBJECTIVETo estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) among patients with severe obesity and T2D, stratified by T2D severity. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used a microsimulation model to project health and cost outcomes of medical therapy, SG, and RYGB over 5 years. Time horizons varied between 10 and 30 years in sensitivity analyses. Model inputs were derived from clinical trials, large cohort studies, national databases, and published literature. Probabilistic sampling of model inputs accounted for parameter uncertainty. Estimates of US adults with severe obesity and T2D were derived from the National Health and Nutrition Examination Survey. Data analysis was performed from January 2020 to August 2021. EXPOSURES Medical therapy, SG, and RYGB. MAIN OUTCOMES AND MEASURESQuality-adjusted life-years (QALYs), costs (in 2020 US dollars), and incremental cost-effectiveness ratios (ICERs) were projected, with future cost and QALYs discounted 3.0% annually. A strategy was deemed cost-effective if the ICER was less than $100 000 per QALY. The preferred strategy resulted in the greatest number of QALYs gained while being costeffective. RESULTSThe model simulated 1000 cohorts of 10 000 patients, of whom 16% had mild T2D, 56% had moderate T2D, and 28% had severe T2D at baseline. The mean age of simulated patients was 54.6 years (95% CI, 54.2-55.0 years), 61.6% (95% CI, 60.1%-63.4%) were female, and 65.1% (95% CI, 63.6%-66.7%) were non-Hispanic White.

Current treatment landscape for obesity in Singapore

“…However, in the long term, surgery is likely to be more cost-effective, given the high costs of these drugs. [ 85 86 ] EBTs can be considered in those who prefer less-invasive options; they can induce reasonable weight loss and improve the comorbid conditions.…”

Long‐term impact of weight loss for people with overweight but not obesity, and with type 2 diabetes: 10‐year outcomes of a randomized trial of gastric band surgery

“…Economic analyses based primarily on observational datasets conclude that bariatric surgery is a cost‐effective intervention for people with type 2 diabetes who are overweight 31‐33 . These analyses assume surgery improves quality of life, decreases medical costs and prevents glucose‐dependent diabetes complications over many decades.…”

“…30 Economic analyses based primarily on observational datasets conclude that bariatric surgery is a cost-effective intervention for people with type 2 diabetes who are overweight. [31][32][33] These analyses assume surgery improves quality of life, decreases medical costs and prevents glucose-dependent diabetes complications over many decades. Our previous cost-effectiveness analysis concluded that, over 10 years, the incremental cost-effectiveness ratio of GB surgery of people with type 2 diabetes who were overweight but not obese was US$29 000 per quality-adjusted life year.…”

Power-assisted Liposuction for Lymphedema: A Cost-utility Analysis

“…Past publications in other specialties have compared nonsurgical approaches to surgical approaches when addressing clinical treatments, empirically justifying this analysis approach. 18,19 Fig. 4.…”