肥胖症手术干预对美国 2 型糖尿病成年患者的长期价值。
The Long-term Value of Bariatric Surgery Interventions for American Adults With Type 2 Diabetes Mellitus.
机构信息
RAND Corporation, Santa Monica, CA.
Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA.
出版信息
Ann Surg. 2023 May 1;277(5):789-797. doi: 10.1097/SLA.0000000000005517. Epub 2022 Jul 8.
BACKGROUND
Bariatric surgery can cause type 2 diabetes (diabetes) remission for individuals with comorbid obesity, yet utilization is <1%. Surgery eligibility is currently limited to body mass index (BMI) ≥35 kg/m 2 , though the American Diabetes Association recommends expansion to BMI ≥30 kg/m 2 .
OBJECTIVE
We estimate the individual-level net social value benefits of diabetes remission through bariatric surgery and compare the population-level effects of expanding eligibility alone versus improving utilization for currently eligible individuals.
METHODS
Using microsimulation, we quantified the net social value (difference in lifetime health/economic benefits and costs) of bariatric surgery-related diabetes remission for Americans with obesity and diabetes. We compared projected lifetime surgical outcomes to conventional management at individual and population levels for current utilization (1%) and eligibility (BMI ≥35 kg/m 2 ) and expansions of both (>1%, and BMI ≥30 kg/m 2 ).
RESULTS
The per capita net social value of bariatric surgery-related diabetes remission was $264,670 (95% confidence interval: $234,527-294,814) under current and $227,114 (95% confidence interval: $205,300-248,928) under expanded eligibility, an 11.1% and 9.16% improvement over conventional management. Quality-adjusted life expectancy represented the largest gains (current: $194,706; expanded: $169,002); followed by earnings ($51,395 and $46,466), and medical savings ($41,769 and $34,866) balanced against the surgery cost ($23,200). Doubling surgical utilization for currently eligible patients provides higher population gains ($34.9B) than only expanding eligibility at current utilization ($29.0B).
CONCLUSIONS
Diabetes remission following bariatric surgery improves healthy life expectancy and provides net social benefit despite high procedural costs. Per capita benefits appear greater among currently eligible individuals. Therefore, policies that increase utilization may produce larger societal value than expanding eligibility criteria alone.
背景
减重手术可以使合并肥胖症的 2 型糖尿病（糖尿病）患者痊愈，但利用率却<1%。目前，手术的入选标准仅限于体重指数（BMI）≥35kg/m²，而美国糖尿病协会建议扩大到 BMI≥30kg/m²。
目的
我们估计通过减重手术使糖尿病痊愈的个体净社会效益，并比较单独扩大入选标准与提高目前合格人群利用率的人群水平效应。
方法
我们使用微观模拟技术，量化了肥胖和糖尿病美国人通过减重手术相关的糖尿病痊愈的净社会效益（终生健康/经济效益和成本的差异）。我们在个体和人群水平上比较了当前利用率（1%）和入选标准（BMI≥35kg/m²）以及两者扩大（>1%和 BMI≥30kg/m²）情况下的预测终生手术结果与常规管理。
结果
在当前情况下，减重手术相关糖尿病痊愈的人均净社会效益为 264670 美元（95%置信区间：234527-294814），在扩大入选标准情况下为 227114 美元（95%置信区间：205300-248928），与常规管理相比，分别提高了 11.1%和 9.16%。质量调整寿命预期代表了最大的收益（当前：194706 美元；扩大：169002 美元）；其次是收入（51395 美元和 46466 美元）和医疗储蓄（41769 美元和 34866 美元），与手术成本（23200 美元）相平衡。与仅扩大当前利用率的入选标准相比，提高目前合格患者的手术利用率（349 亿美元）可带来更高的人群收益（290 亿美元）。
结论
尽管手术程序成本较高，但减重手术后糖尿病痊愈可提高健康预期寿命并带来净社会效益。目前合格人群的人均效益似乎更大。因此，增加利用率的政策可能比单独扩大入选标准产生更大的社会价值。
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