Coreva Scientific, Königswinter, Germany.
Front Public Health. 2020 Sep 30;8:515. doi: 10.3389/fpubh.2020.00515. eCollection 2020.
Effective provision of bariatric surgery for patients with obesity may be impeded by concerns of payers regarding costs or perceptions of patients who drop out of surgical programs after referral. Estimates of the cost and comorbidity impact of these inefficiencies in gastric bypass surgery in Canada are lacking but would aid in informing healthcare investment and resource allocation. To estimate total and relative public payer costs for surgery and comorbidities (diabetes, hypertension, and dyslipidemia) in a bariatric surgery population. A decision analytic model for a 100-patient cohort in Canada (91% female, mean body mass index 49.2 kg/m, 50% diabetes, 66% hypertension, 59% dyslipidemia). Costs include surgery, surgical complications, and comorbidities over the 10-year post-referral period. Results are calculated as medians and 95% credibility intervals (CrIs) for a pathway with surgery at 1 year ("improved") compared with surgery at 3.5 years ("standard"). Sensitivity analyses were performed to test independent contributions to results of shorter wait time, better post-surgical weight loss, and randomly sampled cohort demographics. Compared to standard care, the improved path was associated with reduction in patient-years of treatment for each of the three comorbidities, corresponding to a reduction of $1.1 (0.68-1.6) million, or 34% (26-41%) of total costs. Comorbidity treatment costs were 9.0- and 4.7-fold greater than surgical costs for the standard and improved pathways, respectively. Relative to non-surgical bariatric care, earlier surgery was associated with earlier return on surgical investment and 2-fold reduction in risk of prevalence of each comorbidity compared to delayed surgery. Comorbidity costs represent a greater burden to payers than the costs of gastric bypass surgery. Investments may be worthwhile to reduce wait times and dropout rates and improve post-surgical weight loss outcomes to save overall costs and reduce patient comorbidity prevalence.
有效的肥胖症患者减重手术的提供可能会受到支付方对成本的担忧或对转诊后退出手术项目的患者看法的影响。缺乏加拿大胃旁路手术这些效率低下的成本和合并症影响的估计，但这将有助于为医疗保健投资和资源配置提供信息。目的：估计肥胖症手术人群中手术和合并症（糖尿病、高血压和血脂异常）的总公共支付者成本和相对成本。为加拿大 100 名患者队列（91%为女性，平均体重指数为 49.2kg/m，50%患有糖尿病，66%患有高血压，59%患有血脂异常）构建决策分析模型。成本包括手术、手术并发症和转诊后 10 年内的合并症。结果以路径的中位数和 95%可信区间（CrI）计算，该路径在 1 年（“改善”）而不是在 3.5 年（“标准”）进行手术。进行敏感性分析以检验较短等待时间、更好的术后减重和随机抽样队列人口统计学对结果的独立贡献。与标准治疗相比，改善路径与三种合并症的每个患者年治疗量减少相关，这相当于减少了 110 万美元（68-160 万美元），或总费用的 34%（26-41%）。对于标准和改善途径，合并症治疗成本分别是手术成本的 9.0 倍和 4.7 倍。与非手术减肥治疗相比，早期手术与更早的手术投资回报相关，与延迟手术相比，每种合并症的患病率风险降低了两倍。合并症成本对支付方的负担大于胃旁路手术的成本。减少等待时间和退出率，改善术后减重效果的投资可能是值得的，以节省总费用并降低患者合并症的患病率。
