1
|
Jordan K, Fawsitt CG, Carty PG, Clyne B, Teljeur C, Harrington P, Ryan M. Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:575-590. [PMID: 35869383 PMCID: PMC10175448 DOI: 10.1007/s10198-022-01494-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/21/2022] [Indexed: 05/12/2023]
Abstract
AIM To systematically identify and appraise the international literature on the cost-effectiveness of metabolic surgery for the treatment of comorbid type 2 diabetes (T2D) and obesity. METHODS A systematic search was conducted in electronic databases and grey literature sources up to 20 January 2021. Economic evaluations in a T2D population or a subpopulation with T2D were eligible for inclusion. Screening, data extraction, critical appraisal of methodological quality (Consensus Health Economic Criteria list) and assessment of transferability (International Society for Pharmacoeconomics and Outcomes Research questionnaire) were undertaken in duplicate. The incremental cost-effectiveness ratio (ICER) was the main outcome. Costs were reported in 2020 Irish Euro. Cost-effectiveness was interpreted using willingness-to-pay (WTP) thresholds of €20,000 and €45,000/quality-adjusted life year (QALY). Due to heterogeneity arising from various sources, a narrative synthesis was undertaken. RESULTS Thirty studies across seventeen jurisdictions met the inclusion criteria; 16 specifically in a T2D population and 14 in a subpopulation with T2D. Overall, metabolic surgery was found to be cost-effective or cost-saving. Where undertaken, the results were robust to sensitivity and scenario analyses. Of the 30 studies included, 15 were considered high quality. Identified limitations included limited long-term follow-up data and uncertainty regarding the utility associated with T2D remission. CONCLUSION Published high-quality studies suggest metabolic surgery is a cost-effective or cost-saving intervention. As the prevalence of obesity and obesity-related diseases increases worldwide, significant investment and careful consideration of the resource requirements needed for metabolic surgery programmes will be necessary to ensure that service provision is adequate to meet demand.
Collapse
Affiliation(s)
- Karen Jordan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.
- Health Information and Quality Authority, Dublin, Ireland.
| | | | - Paul G Carty
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
| | - Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor Teljeur
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Mairin Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin 8, Ireland
| |
Collapse
|
2
|
Thaher O, Iaroshevych V, Driouch J, Hukauf M, Croner RS, Stroh C. Current status of metabolic surgery in patients with type I diabetes mellitus and obesity: a nationwide multicenter study. Langenbecks Arch Surg 2023; 408:46. [PMID: 36662321 DOI: 10.1007/s00423-023-02788-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/22/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE While obesity is prevalent among patients with type I diabetes mellitus (T1DM), the effects of metabolic surgery on patients with T1DM have not been adequately investigated. The study aims to investigate the perioperative outcomes and the improvement of comorbidity 1 year following metabolic surgery amongst this patient population. METHODS In this study, we evaluated the effects of sleeve gastrectomy (SG) and Roux-Y gastric bypass (RYGB) on patients with T1DM and insulin resistance. RESULTS One hundred forty-nine patients (SG n = 91 and RYGB n = 58) with obesity, T1DM, and insulin resistance were analyzed. There was no significant difference in BMI reduction and %EWL 1 year after surgery between the two groups. In the SG group, BMI reduction was 6.5 kg/m2 versus 5.9 kg/m2 in the RYGB group (p=0.406). The %EWL was 68.2 ± 25.2 in the RYGB group and 64.3 ± 21.5 in SG (p=0.332). There was also no significant difference in weight loss between the two groups (14.9 ± 5.4 kg in SG vs. 14.2 ± 7 kg in RYGB; p=0.548). In all patients, insulin requirements decreased after surgery, and in 22% of patients, insulin requirements were equivalent to those of normal-weight individuals. There was a significantly higher rate of remission of reflux in RYGB patients than in SG patients (94·44% vs 29·41; p<0.001). CONCLUSION Patients with obesity and T1DM may benefit from metabolic surgery. Both methods produce satisfactory results in this group of patients regarding daily insulin requirements and treatment of obesity-related diseases. However, the decision of which procedure should be carried out still depends on the patient's general condition and the surgeon's technical ability.
Collapse
Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Volodymyr Iaroshevych
- Department of Surgery, SRH Hospital Naumburg, Humboldtstraße 31, 06618, Naumburg, Germany
| | - Jamal Driouch
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Straße des Friedens 122, 07548, Gera, Germany
| |
Collapse
|
3
|
Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences. Obes Surg 2021; 31:3279-3290. [PMID: 33893610 PMCID: PMC8175295 DOI: 10.1007/s11695-021-05415-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
This systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. ![]()
Collapse
|
4
|
Kearns EC, Fearon NM, O'Reilly P, Lawton C, McMackin T, Walsh AM, Geogheghan J, Heneghan HM. Enhanced Recovery After Bariatric Surgery: Feasibility and Outcomes in a National Bariatric Centre. Obes Surg 2021; 31:2097-2104. [PMID: 33417098 DOI: 10.1007/s11695-020-05220-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to assess outcomes of bariatric surgical procedures after the implementation of an enhanced recovery after bariatric surgery protocol in the National Bariatric Centre in Ireland. MATERIALS AND METHODS Data on consecutive bariatric procedures performed over a 36-month period was prospectively recorded. ERABS interventions utilized included preoperative counselling, shortened preoperative fasts, specific anaesthetic protocols, early postop mobilization and feeding, and extended post-discharge thromboprophylaxis. RESULTS A total of 280 primary bariatric procedures were performed over a 36-month period. The primary procedures were laparoscopic sleeve gastrectomy (57.5%), laparoscopic one anastomosis gastric bypass (33.2%) and laparoscopic Roux-en-Y gastric bypass (9.3%). Mean (SD) age was 48 (± 10) years, mean (SD) preoperative BMI 49.5 (± 9) kg/m2 and 68% were female. Median ASA score was 3, and median OSMRS also 3. Over 50% of patients had a diagnosis of hypertension or OSA, and over one-third had a diagnosis of type 2 diabetes mellitus or dyslipidemia. All procedures were completed laparoscopically and 29 patients underwent a simultaneous procedure. The mean (SD) length of stay was 2.3 (± 1.4) days (median 2 days, range 2-47 days). Overall postoperative morbidity rate was 10.0% (n = 29). The 30-day readmission and reoperation rates were 3.6% and 2.5% respectively. There was no mortality recorded in this series. CONCLUSION Implementing an ERABS protocol was feasible, safe, associated with low morbidity, no mortality, acceptable LOS and low readmission and reoperation rates. Although patients with obesity have a spectrum of disease-related complications, this should not preclude the use of an ERABS protocol in bariatric surgery.
Collapse
Affiliation(s)
- Emma C Kearns
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. .,St. Vincent's University Hospital, Dublin, Ireland.
| | - Naomi M Fearon
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,National Bariatric Centre, Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Pauric O'Reilly
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,St. Vincent's University Hospital, Dublin, Ireland
| | - Cian Lawton
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Tim McMackin
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Abigail M Walsh
- Department of Anaesthesia and Intensive Care Medicine, St Vincent's University Hospital, Dublin, Ireland
| | - Justin Geogheghan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,National Bariatric Centre, Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Helen M Heneghan
- School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.,National Bariatric Centre, Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| |
Collapse
|
5
|
Premkumar A, Lebrun DG, Sidharthan S, Penny CL, Dodwell ER, McLawhorn AS, Nwachukwu BU. Bariatric Surgery Prior to Total Hip Arthroplasty Is Cost-Effective in Morbidly Obese Patients. J Arthroplasty 2020; 35:1766-1775.e3. [PMID: 32278487 DOI: 10.1016/j.arth.2020.02.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/09/2020] [Accepted: 02/20/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The cost-effectiveness of bariatric surgery to achieve weight loss prior to total hip arthroplasty (THA), and decrease the complications and costs associated with THA in the morbidly obese, is unknown. This study evaluated the cost-effectiveness of bariatric surgery prior to THA for morbidly obese patients with end-stage hip osteoarthritis (OA). METHODS A state-transition Markov model was constructed to compare the cost-utility of 2 treatment protocols for patients with morbid obesity and end-stage hip OA: (1) immediate THA and (2) bariatric surgery 2 years prior to THA (combined protocol). The analysis was performed from both a payer and a societal perspective using direct and indirect costs over a 40-year time horizon. Utilities, associated costs, and probabilities for health state transitions were derived from the literature. One-way, 2-way and probabilistic sensitivity analyses were performed to validate the robustness of the base case results, using the standard willingness-to-pay threshold of $100,000/quality-adjusted life years. RESULTS From the societal perspective, the combined protocol was more effective (13.16 vs 12.26) with less cost ($91,717 vs $92,684) and thus was the dominant strategy over immediate THA. These results were stable across broad ranges for independent model variables. Monte Carlo simulation with 100,000 samples demonstrated that bariatric surgery prior to THA was the preferred cost-effective strategy over 95% of the time from both a societal and payer perspective. CONCLUSION In the morbidly obese patient with end-stage hip OA, bariatric surgery prior to THA is a cost-effective strategy for improving quality of life and decreasing societal and payer costs. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Drake G Lebrun
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Sreetha Sidharthan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Caitlin L Penny
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Emily R Dodwell
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | | |
Collapse
|
6
|
Xia Q, Campbell JA, Ahmad H, Si L, de Graaff B, Palmer AJ. Bariatric surgery is a cost-saving treatment for obesity-A comprehensive meta-analysis and updated systematic review of health economic evaluations of bariatric surgery. Obes Rev 2020; 21:e12932. [PMID: 31733033 DOI: 10.1111/obr.12932] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
Demand for bariatric surgery to treat severe and resistant obesity far outstrips supply. We aimed to comprehensively synthesise health economic evidence regarding bariatric surgery from 1995 to 2018 (PROSPERO registration number: CRD42018094189). Meta-analyses were conducted to calculate the annual cost changes "before" and "after" surgery, and cumulative cost differences between surgical and nonsurgical groups. An updated narrative review also summarized the full and partial health economic evaluations of surgery from September 2015. N = 101 studies were eligible for the qualitative analyses since 1995, with n = 24 studies after September 2015. Quality of reporting has increased, and the inclusion of complications/reoperations was predominantly contained in the full economic evaluations after September 2015. Technical improvements in surgery were also reflected across the studies. Sixty-one studies were eligible for the quantitative meta-analyses. Compared with no/conventional treatment, surgery was cost saving over a lifetime scenario. Additionally, consideration of indirect costs through sensitivity analyses increased cost savings. Medication cost savings were dominant in the before versus after meta-analysis. Overall, bariatric surgery is cost saving over the life course even without considering indirect costs. Health economists are hearing the call to present higher quality studies and include the costs of complications/reoperations; however, indirect costs and body contouring surgery are still not appropriately considered.
Collapse
Affiliation(s)
- Qing Xia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Julie A Campbell
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Hasnat Ahmad
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Tu Y, Wang L, Wei L, Xu Y, Han X, Han J, Yu H, Zheng C, Bao Y, Jia W. Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort. Obes Surg 2019; 29:3978-3986. [DOI: 10.1007/s11695-019-04069-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|