Salem Leon, Devlin Allison, Sullivan Sean D, Flum David R
Department of Surgery, University of Washington School of Medicine, Seattle, Washington 98195-6410, USA.
Surg Obes Relat Dis. 2008 Jan-Feb;4(1):26-32. doi: 10.1016/j.soard.2007.09.009. Epub 2007 Dec 19.
Laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the two most commonly performed bariatric procedures. Although both procedures likely reduce healthcare expenditures related to the resolution of co-morbid conditions, they have different rates of perioperative risks and different rates of associated weight loss. We designed a model to evaluate the incremental cost-effectiveness of these procedures compared with nonoperative weight loss interventions and with each other.
We used a deterministic, payer-perspective model comparing the lifetime expected costs and outcomes of LAGB, LRYGB, and nonoperative treatment. The major endpoints were survival, health-related quality of life, and weight loss. Life expectancy and lifetime medical costs were calculated across age, gender, and body mass index (BMI) strata using previously published data.
For both men and women, LRYGB and LAGB were cost-effective at <$25,000/quality-adjusted life-year (QALY) even when evaluating the full range of baseline BMI and estimates of adverse outcomes, weight loss, and costs. For base-case scenarios in men (age 35 y, BMI 40 kg/m(2)), the incremental cost-effectiveness was $11,604/QALY for LAGB compared with $18,543/QALY for LRYGB. For base-case scenarios in women (age 35 y, BMI 40 kg/m(2)), the incremental cost-effectiveness was $8878/QALY for LAGB compared with $14,680/QALY for LRYGB.
The modeled cost-effectiveness analysis showed that both operative interventions for morbid obesity, LAGB and RYGB, were cost-effective at <$25,000 and that LAGB was more cost-effective than RYGB for all base-case scenarios.
腹腔镜可调节胃束带术（LAGB）和腹腔镜Roux-en-Y胃旁路术（LRYGB）是两种最常用的减肥手术。尽管这两种手术都可能降低与合并症解决相关的医疗保健支出，但它们的围手术期风险率和相关体重减轻率不同。我们设计了一个模型来评估这些手术与非手术减肥干预措施相比以及相互之间的增量成本效益。
我们使用了一个确定性的、支付方视角的模型，比较了LAGB、LRYGB和非手术治疗的终身预期成本和结果。主要终点是生存率、健康相关生活质量和体重减轻。使用先前发表的数据计算了不同年龄、性别和体重指数（BMI）分层的预期寿命和终身医疗成本。
对于男性和女性，即使在评估基线BMI的全范围以及不良结局、体重减轻和成本的估计值时，LRYGB和LAGB的成本效益均低于25,000美元/质量调整生命年（QALY）。对于男性的基线情况（年龄35岁，BMI 40 kg/m²），LAGB的增量成本效益为11,604美元/QALY，而LRYGB为18,543美元/QALY。对于女性的基线情况（年龄35岁，BMI 40 kg/m²），LAGB的增量成本效益为8878美元/QALY，而LRYGB为14,680美元/QALY。
模拟的成本效益分析表明，两种治疗病态肥胖的手术干预措施LAGB和RYGB的成本效益均低于25,000美元，并且在所有基线情况下LAGB比RYGB更具成本效益。
