Johnson & Johnson Medical Devices, New Brunswick, New Jersey, USA.
North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
Surg Obes Relat Dis. 2021 Nov;17(11):1897-1904. doi: 10.1016/j.soard.2021.07.009. Epub 2021 Jul 27.
People living with obesity have been among those most disproportionately impacted by the COVID-19 pandemic, highlighting the urgent need for increased provision of bariatric and metabolic surgery (BMS).
To evaluate the possible clinical and economic benefits of BMS compared with nonsurgical treatment options in the UK, considering the broader impact that COVID-19 has on people living with obesity.
Single-payer healthcare system (National Health Service, England).
A Markov model compared lifetime costs and outcomes of BMS and conventional treatment among patients with body mass index (BMI) ≥ 40 kg/m, BMI ≥ 35 kg/m with obesity-related co-morbidities (Group A), or BMI ≥ 35 kg/m with type 2 diabetes (T2D; Group B). Inputs were sourced from clinical audit data and literature sources; direct and indirect costs were considered. Model outputs included costs and quality-adjusted life years (QALYs). Scenario analyses whereby patients experienced COVID-19 infection, BMS was delayed by five years, and BMS patients underwent endoscopy were conducted.
In both groups, BMS was dominant versus conventional treatment, at a willingness-to-pay threshold of £25,000/QALY. When COVID-19 infections were considered, BMS remained dominant and, across 1000 patients, prevented 117 deaths, 124 hospitalizations, and 161 intensive care unit admissions in Group A, and 64 deaths, 65 hospitalizations, and 90 intensive care unit admissions in Group B. Delaying BMS by 5 years resulted in higher costs and lower QALYs in both groups compared with not delaying treatment.
Increased provision of BMS would be expected to reduce COVID-19-related morbidity and mortality, as well as obesity-related co-morbidities, ultimately reducing the clinical and economic burden of obesity.
肥胖人群受 COVID-19 大流行的影响最为严重，这突显了增加减重和代谢手术（BMS）供应的迫切需要。
考虑到 COVID-19 对肥胖人群的广泛影响，评估英国 BMS 与非手术治疗方案相比可能具有的临床和经济效益。
单一支付者医疗体系（英国国民保健制度）。
采用 Markov 模型比较了 BMI≥40kg/m²、BMI≥35kg/m²且存在肥胖相关合并症（A 组）或 BMI≥35kg/m²且患有 2 型糖尿病（T2D；B 组）的患者中 BMS 和常规治疗的终身成本和结局。投入数据来自临床审计数据和文献资源；考虑了直接和间接成本。模型输出包括成本和质量调整生命年（QALY）。还进行了病例分析，即患者感染 COVID-19、BMS 延迟 5 年以及 BMS 患者接受内镜检查的情况。
在两组中，BMS 相对于常规治疗均具有优势，在 25000 英镑/QALY 的意愿支付阈值下也是如此。考虑到 COVID-19 感染，BMS 仍然具有优势，在 1000 名患者中，A 组预防了 117 例死亡、124 例住院和 161 例重症监护病房入院，B 组预防了 64 例死亡、65 例住院和 90 例重症监护病房入院。与不延迟治疗相比，BMS 延迟 5 年在两组中均导致成本增加和 QALY 降低。
增加 BMS 的供应预计将降低 COVID-19 相关发病率和死亡率，以及肥胖相关合并症，最终减轻肥胖的临床和经济负担。
