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J Diabetes Complications. 2017 Jul;31(7):1139-1144. doi: 10.1016/j.jdiacomp.2017.04.009. Epub 2017 Apr 13.

Cost-effectiveness of gastric band surgery for overweight but not obese adults with type 2 diabetes in the U.S.

Author information

1
Centre for Obesity Research and Education, Monash University, Clayton, Australia; Walter and Eliza Hall Institute, Melbourne University, Parkville, Australia; Royal Melbourne Hospital Department of Medicine, Parkville, Australia. Electronic address: wentworth@wehi.edu.au.
2
School of Population and Global Health, University of Melbourne, Parkville, Australia.
3
Centre for Obesity Research and Education, Monash University, Clayton, Australia.
4
Department of Medicine, University of Chicago, Chicago, IL, USA.

Abstract

AIM:

To determine the cost-effectiveness of gastric band surgery in overweight but not obese people who receive standard diabetes care.

METHOD:

A microsimulation model (United Kingdom Prospective Diabetes Study outcomes model) was used to project diabetes outcomes and costs from a two-year Australian randomized trial of gastric band (GB) surgery in overweight but not obese people (BMI 25 to 30kg/m2) on to a comparable population of U.S. adults from the National Health and Nutrition Examination Survey (N=254). Estimates of cost-effectiveness were calculated based on the incremental cost-effectiveness ratios (ICERs) for different treatment scenarios. Costs were inflated to 2015 U.S. dollar values and an ICER of less than $50,000 per QALY gained was considered cost-effective.

RESULTS:

The incremental cost-effectiveness ratio for GB surgery at two years exceeded $90,000 per quality-adjusted life year gained but decreased to $52,000, $29,000 and $22,000 when the health benefits of surgery were assumed to endure for 5, 10 and 15 years respectively. The cost-effectiveness of GB surgery was sensitive to utility gained from weight loss and, to a lesser degree, the costs of GB surgery. However, the cost-effectiveness of GB surgery was affected minimally by improvements in HbA1c, systolic blood pressure and cholesterol.

CONCLUSIONS:

GB surgery for overweight but not obese people with T2D appears to be cost-effective in the U.S. setting if weight loss endures for more than five years. Health utility gained from weight loss is a critical input to cost-effectiveness estimates and therefore should be routinely measured in populations undergoing bariatric surgery.

KEYWORDS:

Bariatric surgery; Cost-effectiveness; Gastric band surgery; Overweight but not obese; Type 2 diabetes

PMID:
28462893
PMCID:
PMC5528847
DOI:
10.1016/j.jdiacomp.2017.04.009
[Indexed for MEDLINE]
Free PMC Article

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