Wentworth John M, Dalziel Kim M, O'Brien Paul E, Burton Paul, Shaba Frackson, Clarke Philip M, Laiteerapong Neda, Brown Wendy A
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.
School of Population and Global Health, University of Melbourne, Parkville, Australia.
J Diabetes Complications. 2017 Jul;31(7):1139-1144. doi: 10.1016/j.jdiacomp.2017.04.009. Epub 2017 Apr 13.
To determine the cost-effectiveness of gastric band surgery in overweight but not obese people who receive standard diabetes care.
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/m) 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.
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.
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.
确定在接受标准糖尿病护理的超重但非肥胖人群中，胃束带手术的成本效益。
使用微观模拟模型（英国前瞻性糖尿病研究结果模型），将一项针对超重但非肥胖人群（体重指数25至30kg/m²）的胃束带（GB）手术的两年澳大利亚随机试验中的糖尿病结果和成本，推算到来自美国国家健康与营养检查调查的可比美国成年人群体（N = 254）。基于不同治疗方案的增量成本效益比（ICER）计算成本效益估计值。成本按2015年美元价值进行通胀调整，每获得一个质量调整生命年（QALY）的ICER低于50,000美元被认为具有成本效益。
GB手术两年时的增量成本效益比超过每获得一个质量调整生命年90,000美元，但当假设手术的健康益处分别持续5年、10年和15年时，该比值降至52,000美元、29,000美元和22,000美元。GB手术的成本效益对体重减轻所获得的效用敏感，在较小程度上也对GB手术的成本敏感。然而，GB手术的成本效益受糖化血红蛋白（HbA1c）、收缩压和胆固醇改善的影响最小。
在美国，如果体重减轻持续超过五年，对于超重但非肥胖的2型糖尿病患者，GB手术似乎具有成本效益。体重减轻所获得的健康效用是成本效益估计的关键输入因素，因此应在接受减肥手术的人群中常规测量。
