The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus.

Autor:	Chaturvedi R; RAND Corporation, Santa Monica, CA.; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA., Gracner T; RAND Corporation, Santa Monica, CA., Tysinger B; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA., Narain K; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA.; Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA., Goldman D; Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA., Sturm R; RAND Corporation, Santa Monica, CA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 May 01; Vol. 277 (5), pp. 789-797. Date of Electronic Publication: 2022 Jul 08.
DOI:	10.1097/SLA.0000000000005517
Abstrakt:	Background: Bariatric surgery can cause type 2 diabetes (diabetes) remission for individuals with comorbid obesity, yet utilization is <1%. Surgery eligibility is currently limited to body mass index (BMI) ≥35 kg/m 2 , though the American Diabetes Association recommends expansion to BMI ≥30 kg/m 2 . Objective: We estimate the individual-level net social value benefits of diabetes remission through bariatric surgery and compare the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals. Methods: Using microsimulation, we quantified the net social value (difference in lifetime health/economic benefits and costs) of bariatric surgery-related diabetes remission for Americans with obesity and diabetes. We compared projected lifetime surgical outcomes to conventional management at individual and population levels for current utilization (1%) and eligibility (BMI ≥35 kg/m 2 ) and expansions of both (>1%, and BMI ≥30 kg/m 2 ). Results: The per capita net social value of bariatric surgery-related diabetes remission was $264,670 (95% confidence interval: $234,527-294,814) under current and $227,114 (95% confidence interval: $205,300-248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilization for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B). Conclusions: Diabetes remission following bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs. Per capita benefits appear greater among currently eligible individuals. Therefore, policies that increase utilization may produce larger societal value than expanding eligibility criteria alone. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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