The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis.

Autor: Lester ELW; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta. elester@ualberta.ca., Padwal RS; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta., Birch DW; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta., Sharma AM; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta., So H; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta., Ye F; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta., Klarenbach SW; Departments of Surgery (Lester, Birch) and Medicine (Padwal, Sharma, So, Ye, Klarenbach), University of Alberta, Edmonton, Alta.
Jazyk: angličtina
Zdroj: CMAJ open [CMAJ Open] 2021 Jun 18; Vol. 9 (2), pp. E673-E679. Date of Electronic Publication: 2021 Jun 18 (Print Publication: 2021).
DOI: 10.9778/cmajo.20200188
Abstrakt: Background: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives.
Methods: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m 2 and a major medical comorbidity or BMI ≥ 40 kg/m 2 ) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses.
Results: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost-effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis.
Interpretation: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.
Competing Interests: Competing interests: Erica Lester reports support from the Alberta Innovates Health Solutions Clinician Fellowship. Daniel Birch is a founding member of the Canadian Association of Bariatric Physicians and Surgeons. Arya Sharma is a past president of the same association. Scott Klarenbach is supported by the Kidney Health Research Chair. No other competing interests were declared.
(© 2021 CMA Joule Inc. or its licensors.)
Databáze: MEDLINE
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