Finnish Office for Health Technology Assessment, National Institute for Health and Welfare, Helsinki, Finland.
Br J Surg. 2011 Oct;98(10):1422-9. doi: 10.1002/bjs.7640.
The aim of this study was to evaluate the cost-utility of bariatric surgery (gastric bypass, sleeve gastrectomy and gastric banding) compared with ordinary treatment in the Finnish healthcare system.
Analysis was done from a healthcare provider's perspective using a combination of a decision tree and a Markov model, with a time horizon of 10 years. Health-related quality of life was estimated from a representative population survey, and other parameter values were based on registers, systematic reviews, controlled studies and expert opinion.
In the base-case analysis, bariatric surgery was both more effective and less costly than the ordinary treatment. The mean costs were €33,870 and €50,495, and the mean number of quality-adjusted life-years 7·63 and 7·05, for bariatric surgery and ordinary treatment respectively. Uncertainty around the parameter values was tested comprehensively in sensitivity analyses, and the results were robust.
Surgery for morbid obesity increases health-related quality of life, and reduces the need for further treatments and total healthcare costs. According to this analysis, non-operative care would be more costly for the Finnish healthcare system on average after 5 years following surgery.
本研究旨在评估在芬兰医疗体系中，与常规治疗相比，减重手术（胃旁路术、袖状胃切除术和胃束带术）的成本效用。
从医疗服务提供者的角度出发，使用决策树和马尔可夫模型相结合的方法，时间跨度为 10 年。健康相关生活质量是根据代表性人群调查进行评估的，其他参数值则基于登记处、系统评价、对照研究和专家意见。
在基础分析中，减重手术比常规治疗更有效且成本更低。手术组的平均成本为 33870 欧元，而常规治疗组的平均成本为 50495 欧元；手术组的平均质量调整生命年为 7.63，而常规治疗组的平均质量调整生命年为 7.05。对参数值的不确定性进行了全面的敏感性分析，结果是稳健的。
肥胖症手术可提高健康相关生活质量，并减少进一步治疗的需求和总体医疗保健成本。根据这项分析，在手术后 5 年，非手术治疗对芬兰医疗体系的平均成本更高。
