Brigham and Women's Hospital, Boston, Massachusetts.
Brigham and Women's Hospital, Boston, Massachusetts, and Carle Illinois College of Medicine, Champaign.
Arthritis Care Res (Hoboken). 2023 Mar;75(3):491-500. doi: 10.1002/acr.24967. Epub 2022 Nov 17.
Class III obesity (body mass index [BMI] ≥40 kg/m ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m .
We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters.
The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively.
RYGB offers good value among knee OA patients with BMI ≥40 kg/m , while LSG may provide good value among those with BMI between 35 and 41 kg/m .
III 类肥胖（体重指数[BMI]≥40kg/m²）与更严重的膝关节疼痛和全膝关节置换（TKR）结局相关。由于减重手术可使 BMI≥40kg/m²的个体实现可持续的体重减轻，我们的目标是确定 Roux-en-Y 胃旁路术（RYGB）和腹腔镜袖状胃切除术（LSG）结合常规护理对 BMI≥40kg/m²的膝骨关节炎（OA）患者的价值。
我们使用骨关节炎政策模型来评估 RYGB 和 LSG 的长期临床获益、成本和成本效益。我们从已发表的数据中获得了与这些治疗相关的疗效、成本和并发症的模型输入。主要结果包括质量调整生命年（QALY）、终生成本和增量成本效益比（ICER），均按 3%/年贴现。这项分析是从医疗保健部门的角度进行的。我们进行了敏感性分析以评估输入参数的不确定性。
与单独常规护理相比，常规护理+RYGB 策略增加了 1.35 年的质量调整预期寿命，并增加了 7209 美元的终生成本（ICER=5300 美元/QALY）。常规护理+LSG 策略的获益低于常规护理+RYGB，并且被常规护理所主导。与单独常规护理相比，常规护理+RYGB 和常规护理+LSG 分别将阿片类药物的使用从 13%降低到 4%，并将 TKR 的使用从 30%增加到 50%和 41%。对于 BMI 在 38 至 41kg/m²之间的队列，常规护理+LSG 优于常规护理+RYGB。在概率敏感性分析中，在 50000 美元/QALY 的意愿支付阈值下，常规护理+RYGB 和常规护理+LSG 在 70%和 30%的迭代中具有成本效益。
RYGB 为 BMI≥40kg/m²的膝骨关节炎患者提供了良好的价值，而 LSG 可能为 BMI 在 35 至 41kg/m²之间的患者提供良好的价值。
