Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil.
School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.
BMC Health Serv Res. 2022 Jan 7;22(1):41. doi: 10.1186/s12913-021-07432-x.
The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities.
The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery.
The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention.
Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.
肥胖负担的增加给个人、人群和全球卫生系统带来了重大的社会经济影响。关于肥胖相关干预措施预防和治疗中度至重度肥胖的影响和成本效益的文献表明，减重手术在改善健康状况方面具有高效果，同时伴随着与高有效性相关的高成本，这是指某些结果；然而，在个体层面上，缺乏关于其对肥胖合并症相关多种健康结果的影响的强有力证据。
本研究采用单中心回顾性纵向分析患者水平数据，使用微观成本核算技术来估计减重手术后多个健康结果的直接医疗成本和成本效益。通过广义估计方程和边际效应对 2018 年在圣保罗大学临床医院接受减重手术的 114 名患者的患者数据进行了中断时间序列分析，包括患者特征、生活方式、人体测量学指标、血液动力学指标、生化检查以及在减重手术前筛查（180 天）和随访（180 天）期间的医疗资源使用情况。
初步统计分析表明，除胆固醇和 VLDL 外，健康结果有所改善，干预后整体直接医疗成本增加。然而，中断时间序列分析表明，医疗保健成本的增加归因于减重手术的高成本，随后干预后医疗保健成本呈统计学意义下降。除胆固醇和 LDL 外，健康结果的变化也具有统计学意义，这导致患者的健康状况在干预后得到显著改善。
与干预前趋势相比，干预后患者健康状况的多个健康结果呈现出统计学上的显著改善，从而降低了直接医疗成本和肥胖负担。
