Real World Evidence, CTI Clinical Trials and Consulting Services, Covington, KY, USA.
Department of Family, Population and Preventive Medicine, Stony Brook University, 100 Nicolls Road, Stony Brook, NY, 11790, USA.
Obes Surg. 2018 Jun;28(6):1711-1723. doi: 10.1007/s11695-017-3085-8.
The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period.
Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed.
The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8).
Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.
本研究旨在估算在（1）无限制、（2）预算限制（每年 50 万美元）和（3）数量限制（每年 100 例）医疗福利计划情景下，以及在非覆盖范围内，对 10 年内接受减重手术的肥胖患者和 2 型糖尿病（T2DM）患者的支付方预算影响。
利用最近发表的文献和卫生技术评估报告，该模型评估了在当前现实趋势下的一个假设支付方人群，即 10 万成员：体重指数定义的肥胖群体（31.3%正常/体重不足，33%超重，20.4%肥胖，9%严重肥胖，6.3%病态肥胖）、T2DM 患病率（6.7%-27.5%；T2DM 模型为 100%）、手术类型（LAGB、BPD/DS、VSG 和 RYGB）以及不同的结果（T2DM 缓解率、成本和再次手术率及并发症率）。假设符合条件的候选人中有 1.42%的手术选择率，采用 3%的贴现率和 10%的年手术周转率，通过估计非 T2DM 和 T2DM 相关预期成本和节省的差异，计算每位成员每月的增量成本（PMPM）。进行了单边（±25%）敏感性分析。
在多种情况下，为一般人群（或 T2DM 人群）覆盖减重手术的影响，第一年每个成员每月额外增加 0.3 至 3.6 美元（T2DM：0.3 至 10.5 美元）。随着时间的推移，增量成本逐渐减少，在第 5 年至第 9 年之间收支平衡（T2DM：5-6 年），到第 10 年，预计将节省 1.5 至 4.8 美元（T2DM：1.2 美元至 31.8 美元）。
为减重手术提供覆盖可能会在短期内增加适度的预算影响，但会导致一般人群模型的长期净成本节省。在 T2DM 模型中，节省的成本更为显著。
