Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong SAR, China.
Department of Surgery, Prince of Wales Hospital, Hong Kong SAR, China.
Br J Surg. 2021 May 27;108(5):554-565. doi: 10.1002/bjs.11970.
Bariatric surgery can be effective in weight reduction and diabetes remission in some patients, but is expensive. The costs of bariatric surgery in patients with obesity and type 2 diabetes mellitus (T2DM) were explored here.
Population-based retrospectively gathered data on patients with obesity and T2DM from the Hong Kong Hospital Authority (2006-2017) were evaluated. Direct medical costs from baseline up to 60 months were calculated based on the frequency of healthcare service utilization and dispensing of diabetes medication. Charlson Co-morbidity Index (CCI) scores and co-morbidity rates were measured to compare changes in co-morbidities between surgically treated and control groups over 5 years. One-to-five propensity score matching was applied.
Overall, 401 eligible surgical patients were matched with 1894 non-surgical patients. Direct medical costs were much higher for surgical than non-surgical patients in the index year (€36 752 and €5788 respectively; P < 0·001) mainly owing to the bariatric procedure. The 5-year cumulative costs incurred by surgical patients were also higher (€54 135 versus €28 603; P < 0·001). Although patients who had bariatric surgery had more visits to outpatient and allied health professionals than those who did not across the 5-year period, surgical patients had shorter length of stay in hospitals than non-surgical patients in year 2-5. Surgical patients had significantly better CCI scores than controls after the baseline measurement (mean 3·82 versus 4·38 at 5 years; P = 0·016). Costs of glucose-lowering medications were similar between two groups, except that surgical patients had significantly lower costs of glucose-lowering medications in year 2 (€973 versus €1395; P = 0.012).
Bariatric surgery in obese patients with T2DM is expensive, but leads to an improved co-morbidity profile, and reduced length of hospitalization.
减重手术可以有效降低部分患者的体重并缓解糖尿病，但费用较高。本研究旨在探讨肥胖合并 2 型糖尿病（T2DM）患者行减重手术的成本。
本研究基于香港医院管理局（2006-2017 年）的人群回顾性数据，评估肥胖合并 T2DM 患者的相关信息。根据医疗服务利用频次和糖尿病药物使用情况计算基线至 60 个月的直接医疗成本。采用 Charlson 合并症指数（CCI）评分和合并症发生率来比较 5 年内手术组和对照组合并症的变化。采用 1:5 倾向评分匹配法进行匹配。
共纳入 401 例手术患者和 1894 例非手术患者进行匹配。手术患者的索引年直接医疗成本显著高于非手术患者（€36752 比 €5788；P<0.001），主要是因为减重手术。手术患者的 5 年累计成本也更高（€54135 比 €28603；P<0.001）。尽管手术组患者在 5 年内门诊和其他卫生专业人员就诊次数多于非手术组，但在第 2-5 年，手术组患者的住院时间短于非手术组。与基线测量相比，手术后患者的 CCI 评分显著低于对照组（5 年时平均值为 3.82 比 4.38；P=0.016）。两组患者降糖药物的费用相似，但手术组患者在第 2 年的降糖药物费用明显较低（€973 比 €1395；P=0.012）。
肥胖合并 T2DM 患者行减重手术费用较高，但可改善合并症状况，减少住院时间。
