腹腔镜 Roux-en-Y 胃旁路术治疗中国 BMI≥27.5kg/m2 的 2 型糖尿病肥胖患者的成本-效用：一项具有 4 年手术队列随访的多中心研究。
Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort.
机构信息
Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China.
出版信息
Obes Surg. 2019 Dec;29(12):3978-3986. doi: 10.1007/s11695-019-04069-y.
OBJECTIVES
To find whether Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery was cost effective compared to conventional medical management (CMM) in Chinese patients with type 2 Diabetes(T2D) and obesity with a body mass index (BMI) ≥27.5 kg/m in four years.
METHODS
A total of 106 obese T2D individuals who underwent RYGB and 106 T2D patients treated with CMM were enrolled from three academic medical centers. Total health related costs, Glycated Hemoglobin A1c (A1C) and BMI was recorded. Cost-Utility Analysis (CUA) was used. Utility values according to results of A1c were obtained from published studies.
RESULTS
Improvements were observed in A1C (8.6% at baseline to 6.2% in the first year, p < 0.001) and BMI (30.7 kg/m at baseline to 24.3 kg/m in the first year, p < 0.001), and the effect lasted for 4 years after RYGB. In the CMM group, A1C fluctuated in four years. The health utility for RYGB group scores 3.756, whereas CMM group scores 3.594 in four years. The total healthcare costs decreased sharply from the second year after RYGB ($8,483 [¥52,596] in the first year to $672[¥4,164] in the second year, p < 0.001) and maintained for 3 years. In the CMM group, the total healthcare costs changed without significance. RYGB costs US$19,359 (¥125,836) per quality-adjusted life years (QALY) gained (incremental cost-utility ratio [ICUR]) compared to CMM, which was lower than a willingness-to-pay (WTP) of $20,277/QALY.
CONCLUSIONS
Compared to CMM, RYGB is cost-effective for Chinese patients with type 2 diabetes and obesity 4 years after operation.
目的
比较腹腔镜 Roux-en-Y 胃旁路手术（RYGB）与常规药物治疗（CMM）对中国肥胖 2 型糖尿病（T2D）患者的成本效益，这些患者的 BMI≥27.5kg/m2。
方法
共纳入来自 3 家学术医疗中心的 106 例肥胖 T2D 患者，RYGB 组和 T2D 患者 106 例，CMM 组。记录总健康相关费用、糖化血红蛋白（A1C）和 BMI。采用成本效用分析（CUA）。根据 A1c 结果获得效用值来自已发表的研究。
结果
RYGB 术后 A1C（基线 8.6%，第 1 年 6.2%，p<0.001）和 BMI（基线 30.7kg/m2，第 1 年 24.3kg/m2，p<0.001）均有改善，并且这种效果持续了 4 年。CMM 组 4 年期间 A1C 波动。RYGB 组的健康效用评分 3.756，CMM 组 4 年的健康效用评分 3.594。RYGB 术后第 2 年总医疗费用大幅下降（第 1 年 8483 美元（52596 元）至第 2 年 672 美元（4164 元），p<0.001），并维持了 3 年。CMM 组总医疗费用无显著变化。RYGB 每获得 1 个质量调整生命年（QALY）的成本为 19359 美元（125836 元）（增量成本效用比[ICUR]），低于 20277 美元/QALY 的意愿支付（WTP）。
结论
与 CMM 相比，RYGB 对中国肥胖 2 型糖尿病患者在术后 4 年内具有成本效益。
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