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. 2010 Sep;33(9):1933-9.
doi: 10.2337/dc10-0554.

Cost-effectiveness of bariatric surgery for severely obese adults with diabetes

Thomas J Hoerger  1 , Ping Zhang, Joel E Segel, Henry S Kahn, Lawrence E Barker, Steven Couper
Affiliations

Cost-effectiveness of bariatric surgery for severely obese adults with diabetes

Thomas J Hoerger et al. Diabetes Care. 2010 Sep.

Abstract

Objective: To analyze the cost-effectiveness of bariatric surgery in severely obese (BMI >or=35 kg/m(2)) adults who have diabetes, using a validated diabetes cost-effectiveness model.

Research design and methods: We expanded the Centers for Disease Control and Prevention-RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes.

Results: In all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery.

Conclusions: Our analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.

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Figures

Figure 1
Figure 1
Sensitivity analyses: cost-effectiveness ratios for lower and upper bound of input values. The range of cost-effectiveness ratios after varying input parameters. For example, using the 95% CI values of remission for bariatric surgery in newly diagnosed patients, we find cost-effectiveness ratios ranging from $6,000 to $8,000/QALY. A QoL improvement of 0.017 leads to a lower cost-effectiveness ratio, and an improvement of 0 leads to a higher cost-effectiveness ratio. Doubling tight glycemic control costs leads to a lower cost-effectiveness ratio, and halving them leads to a higher cost-effectiveness ratio.
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References

    1. Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I: Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009;122:248–256 - PubMed
    1. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugarman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG: Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005;142:547–559 - PubMed
    1. Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–2693 - PubMed
    1. Sjostrom L, Narbro K, Sjostrom D, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindross AK, Lonroth H, Naslund I, Olbers T, Stenlof K, Torgerson J, Agren G, Carlsson LMS: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007;357:741–752 - PubMed
    1. Encinosa WE, Bernard DM, Steiner CA, Chen CC: Use and costs of bariatric surgery and prescription weight-loss medications. Health Affairs 2005;24:1039–1046 - PubMed

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