Ademi Zanfina, Tomonaga Yuki, van Stiphout Joris, Glinz Dominik, Gloy Viktoria, Raatz Heike, Bucher Heiner C, Schwenkglenks Matthias
Institute of Pharmaceutical Medicine (ECPM), University of Basel, Switzerland / School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Epidemiology, Biostatistics und Prevention Institute (EBPI), University of Zürich, Switzerland.
Swiss Med Wkly. 2018 Jun 12;148:w14626. doi: 10.4414/smw.2018.14626. eCollection 2018.
The aims of this study were to (a) identify and assess the quality of reporting of published cost-effectiveness studies of bariatric surgery, (b) assess their transferability to Switzerland, and (c) adapt transferable cost-effectiveness results to Switzerland.
A systematic literature search was performed in Medline, Embase and other databases. Two reviewers independently undertook screening, extraction, assessment of reporting quality utilising the Consolidated Health Economic Evaluation Reporting Standards, transferability, adaptation of cost data and recalculation of cost-effectiveness results. Cost data were adapted in three steps: correction for different levels of resource utilisation, for different prices of healthcare services and for change in costs over time.
Fifteen studies fulfilled criteria for adaptation of cost data to Switzerland. Four out of fifteen adapted studies with a long time-horizon for patients with a body mass index (BMI) >35kg/m2 indicated bariatric surgery to be a cost-saving (dominant) approach compared with conventional treatment. Other studies for patients with BMI >35kg/m2 showed cost-effective results, with incremental cost-effectiveness ratios (ICERs) below CHF 50,000 per quality adjusted life-year (QALY) gained. Two studies assessed cost-effectiveness for patients with BMI <35kg/m2, and revealed ICERs below 50,000 per QALY gained for bariatric surgery versus conventional treatment. Between-study differences were related to approaches for the modelling effectiveness and costs, time horizon, population, type of intervention and possibly other unidentified reasons. Gastric bypass appeared to be superior to gastric banding, but was more expensive.
Nearly all studies found bariatric surgery to be a cost saving or cost-effective compared with conventional treatment. The adaptation of existing cost-effectiveness analyses cannot be considered to give accurate ICERs for Switzerland, but may have achieved an approximation of cost-effectiveness levels to be expected for Switzerland. It has made the results of international cost-effectiveness studies reported for different countries and in different currencies more comparable, and may be useful for individual countries in which financing or capacity for economic analyses is scarce.
本研究的目的是：(a) 识别并评估已发表的减肥手术成本效益研究的报告质量；(b) 评估这些研究结果对瑞士的可转移性；(c) 将可转移的成本效益结果适用于瑞士。
在Medline、Embase和其他数据库中进行了系统的文献检索。两名评审员独立进行筛选、提取，并利用综合卫生经济评价报告标准评估报告质量、可转移性、成本数据的调整以及成本效益结果的重新计算。成本数据分三步进行调整：针对不同的资源利用水平、不同的医疗服务价格以及成本随时间的变化进行校正。
15项研究符合将成本数据适用于瑞士的标准。15项适应性研究中有4项对体重指数（BMI）>35kg/m² 的患者采用了较长的时间跨度，结果表明与传统治疗相比，减肥手术是一种节省成本（占优）的方法。其他针对BMI>35kg/m² 患者的研究显示出具有成本效益的结果，每获得一个质量调整生命年（QALY）的增量成本效益比（ICER）低于50,000瑞士法郎。两项研究评估了BMI<35kg/m² 患者的成本效益，结果显示减肥手术相对于传统治疗每获得一个QALY的ICER低于50,000。研究间的差异与效果和成本建模方法、时间跨度、人群、干预类型以及可能其他未明确的原因有关。胃旁路手术似乎优于胃束带手术，但成本更高。
几乎所有研究都发现与传统治疗相比，减肥手术具有节省成本或成本效益。现有的成本效益分析的调整不能被认为能为瑞士给出准确的ICER，但可能已经实现了对瑞士预期成本效益水平的近似估计。它使以不同国家和不同货币报告的国际成本效益研究结果更具可比性，对于经济分析资金或能力稀缺的个别国家可能有用。
