Boston Health Economics, 20 Fox Rd, Waltham, MA 02451. E-mail:
Am J Manag Care. 2017 Aug 1;23(8):e245-e252.
To assess the lifetime cost-effectiveness of intermittent, reversible vagal nerve blocking (via the implantable weight loss device vBloc) therapy versus conventional therapy as treatment for patients who are class 2 obese with diabetes and for those who are class 3 obese with or without diabetes, who have found pharmacotherapy and behavioral therapies ineffective, but are not prepared or willing to undergo current bariatric surgical options.
A cost-effectiveness model was designed to simulate weight loss, diabetes remission, and costs in patients with obesity undergoing vagal nerve blocking therapy versus conventional therapy.
The model compared 2 treatment arms, vagal nerve blocking therapy and conventional therapy, and for each treatment arm included 4 health states based on body mass index (BMI) class. Using Monte Carlo simulation, patients entered the model one at a time and could transition between health states by experiencing BMI change. The model focused on change in BMI and diabetes remission as predictors of healthcare costs, health-related quality of life, and survival. Inputs for vagal nerve blocking effectiveness were obtained from the ReCharge trial; however, remaining inputs were estimated from published literature. Incremental cost-effectiveness ratios (ICERs) were evaluated in terms of cost per quality-adjusted life-year (QALY) gained.
ICERs for vagal nerve blocking versus conventional therapy in patients who were class 2 and class 3 obese were estimated to be $17,274 and $21,713 per QALY gained, respectively. Sensitivity analyses showed results to be robust to reasonable variation in model inputs, with the upper limit of ICERs remaining below $30,000 for all sensitivity analysis scenarios assessed.
Vagal nerve blocking therapy provides a cost-effective alternative to conventional therapy in patients who are class 2 obese with diabetes and in those who are class 3 with or without diabetes.
评估间歇性、可逆转的迷走神经阻断（通过可植入的减重装置 vBloc）治疗与常规治疗作为 2 型肥胖合并糖尿病患者和 3 型肥胖伴或不伴糖尿病患者的治疗方法的终生成本效益，这些患者对药物治疗和行为疗法均无效，但不愿意或无法接受当前的减重手术选择。
设计了一个成本效益模型，以模拟肥胖患者接受迷走神经阻断治疗与常规治疗的体重减轻、糖尿病缓解和成本情况。
该模型比较了迷走神经阻断治疗和常规治疗这两种治疗方法，并为每个治疗方法包括了 4 种基于体重指数（BMI）类别的健康状态。使用蒙特卡罗模拟，患者一次一人进入模型，并通过 BMI 变化在健康状态之间转换。该模型主要关注 BMI 的变化和糖尿病缓解作为医疗保健成本、健康相关生活质量和生存的预测因素。迷走神经阻断效果的输入数据来自 ReCharge 试验；然而，其余的输入数据是从已发表的文献中估计的。增量成本效益比（ICER）是根据每获得一个质量调整生命年（QALY）的成本来评估的。
在 2 型和 3 型肥胖患者中，迷走神经阻断与常规治疗的 ICER 估计分别为每获得一个 QALY 增加 17274 美元和 21713 美元。敏感性分析表明，在模型输入的合理变化下，结果是稳健的，在所有评估的敏感性分析场景中，ICER 的上限仍低于 30000 美元。
在 2 型肥胖合并糖尿病患者和 3 型肥胖伴或不伴糖尿病患者中，迷走神经阻断治疗是常规治疗的一种具有成本效益的替代方法。
