Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK.
Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
Obes Surg. 2019 Feb;29(2):474-484. doi: 10.1007/s11695-018-3553-9.
There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom.
Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients' first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs.
Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4-6%). Reducing prices of consumables by 20% reduced costs by 10-13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7-10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982).
These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required.
人们对比较替代形式的减重手术的效果和成本越来越感兴趣。我们旨在研究英国 Roux-en-Y 胃旁路术（RYGB）、袖状胃切除术（SG）和可调胃束带术（AGB）的单人手术费用。
多中心（两家英国国家医疗服务体系 NHS 和一家私立医院）微观成本，使用时间和动作研究。前瞻性收集 12 名患者（4 名 RYGB、5 名 SG、3 名 AGB）的手术时间、人员数量、设备、仪器和消耗品，从患者手术当天首次与外科医生互动到离开手术室恢复区。根据数量和平均成本进行成本比较。敏感性和情景分析分别评估了手术输入的变化以及对总费用的其他可能因素的考虑的影响。
RYGB 的平均程序费用为 5002 英镑，SG 为 4306 英镑，AGB 为 2527 英镑。人员资历的变化或手术时间的改变对成本的影响较小（±4-6%）。如果将消耗品价格降低 20%，则可以降低 10-13%的成本。通过改变使用的订书钉重新加载次数来考虑手术技术的差异，会使成本波动±7-10%。从情景分析得出的调整后的总费用与 RYGB 和 SG 的 NHS 收费标准相似（差异分别为 51 英镑和-119 英镑），但 AGB 的费用要低得多（差异为 1982 英镑）。
这些详细的成本将有助于更精确地报销减重手术，并支持对成本效益的全面评估。需要进一步研究术后护理、再次手术和患者术后终身支持的成本。
