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BMC Health Serv Res. 2020 Apr 3;20(1):278. doi: 10.1186/s12913-020-5042-9.
Bariatric surgery, such as Roux-en-Y gastric bypass [RYGB] has been shown to be an effective intervention for weight management in select patients. After surgery, different patients respond differently even to the same surgery and have differing weight-change trajectories. The present analysis explores how improving a patient's post-surgical weight change could impact co-morbidity prevalence, treatment and associated costs in the Canadian setting.
Published data were used to derive statistical models to predict weight loss and co-morbidity evolution after RYGB. Burden in the form of patient-years of co-morbidity treatment and associated costs was estimated for a 100-patient cohort on one of 6 weight trajectories, and for real-world simulations of mixed patient cohorts where patients experience multiple weight loss outcomes over a 10-year time horizon after RYGB surgery. Costs (2018 Canadian dollars) were considered from the Canadian public payer perspective for diabetes, hypertension and dyslipidaemia. Robustness of results was assessed using probabilistic sensitivity analyses using the R language.
Models fitted to patient data for total weight loss and co-morbidity evolution (resolution and new onset) demonstrated good fitting. Improvement of 100 patients from the worst to the best weight loss trajectory was associated with a 50% reduction in 10-year co-morbidity treatment costs, decreasing to a 27% reduction for an intermediate improvement. Results applied to mixed trajectory cohorts revealed that broad improvements by one trajectory group for all patients were associated with 602, 1710 and 966 patient-years of treatment of type 2 diabetes, hypertension and dyslipidaemia respectively in Ontario, the province of highest RYGB volume, corresponding to a cost difference of $3.9 million.
Post-surgical weight trajectory, even for patients receiving the same surgery, can have a considerable impact on subsequent co-morbidity burden. Given the potential for alleviated burden associated with improving patient trajectory after RYGB, health care systems may wish to consider investments based on local needs and available resources to ensure that more patients achieve a good long-term weight trajectory.
减重手术，如 Roux-en-Y 胃旁路术（RYGB）已被证明是一种针对特定患者的有效体重管理干预措施。手术后，即使接受相同的手术，不同患者的反应也不同，体重变化轨迹也不同。本分析探讨了改善患者手术后的体重变化如何影响加拿大的共病患病率、治疗和相关成本。
使用已发表的数据来推导出预测 RYGB 后体重减轻和共病演变的统计模型。对于 100 名患者队列中的 6 种体重轨迹之一，以及对于经历 RYGB 手术后 10 年内多次体重减轻结果的混合患者队列的实际模拟，以患者年为单位估计共病治疗和相关成本的负担。从加拿大公共支付者的角度考虑了糖尿病、高血压和血脂异常的成本（2018 年加拿大元）。使用 R 语言进行概率敏感性分析评估了结果的稳健性。
对患者数据进行拟合的总体重减轻和共病演变（解决和新发病例）模型显示拟合良好。将 100 名患者从最差体重减轻轨迹改善到最佳体重减轻轨迹，与 10 年共病治疗成本降低 50%相关，而对于中等程度的改善，则降低至 27%的降低。将结果应用于混合轨迹队列表明，对于所有患者，一个轨迹组的广泛改善与安大略省（RYGB 量最高的省份）2 型糖尿病、高血压和血脂异常的治疗分别减少 602、1710 和 966 个患者年，相当于 390 万加元的成本差异。
即使对于接受相同手术的患者，手术后的体重轨迹也可能对随后的共病负担产生重大影响。鉴于改善 RYGB 后患者轨迹可能减轻负担，医疗保健系统可能希望根据当地需求和可用资源考虑投资，以确保更多患者实现良好的长期体重轨迹。
