Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA.
Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA.
Gut. 2023 Nov 24;72(12):2250-2259. doi: 10.1136/gutjnl-2023-330437.
Weight loss interventions to treat obesity include sleeve gastrectomy (SG), lifestyle intervention (LI), endoscopic sleeve gastroplasty (ESG) and semaglutide. We aimed to identify which treatments are cost-effective and identify requirements for semaglutide to be cost-effective.
We developed a semi-Markov microsimulation model to compare the effectiveness of SG, ESG, semaglutide and LI for weight loss in 40 years old with class I/II/III obesity. Extensive one-way sensitivity and threshold analysis were performed to vary cost of treatment strategies and semaglutide adherence rate. Outcome measures were incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay threshold of US$100 000/quality-adjusted life-year (QALY).
When strategies were compared with each other, ESG was cost-effective in class I obesity (US$4105/QALY). SG was cost-effective in class II obesity (US$5883/QALY) and class III obesity (US$7821/QALY). In class I/II/III, obesity, SG and ESG were cost-effective compared with LI. However, semaglutide was not cost-effective compared with LI for class I/II/III obesity (ICER US$508 414/QALY, US$420 483/QALY and US$350 637/QALY). For semaglutide to be cost-effective compared with LI, it would have to cost less than US$7462 (class III), US$5847 (class II) or US$5149 (class I) annually. For semaglutide to be cost-effective when compared with ESG, it would have to cost less than US$1879 (class III), US$1204 (class II) or US$297 (class I) annually.
Cost-effective strategies were: ESG for class I obesity and SG for class II/III obesity. Semaglutide may be cost-effective with substantial cost reduction. Given potentially higher utilisation rates with pharmacotherapy, semaglutide may provide the largest reduction in obesity-related mortality.
治疗肥胖的减肥干预措施包括袖状胃切除术（SG）、生活方式干预（LI）、内镜下胃袖套成形术（ESG）和司美格鲁肽。我们旨在确定哪些治疗方法具有成本效益，并确定司美格鲁肽具有成本效益的要求。
我们开发了一个半马尔可夫微模拟模型，以比较 SG、ESG、司美格鲁肽和 LI 治疗 40 岁 I/II/III 级肥胖患者的减肥效果。进行了广泛的单因素敏感性和阈值分析，以改变治疗策略和司美格鲁肽依从率的成本。结果指标是增量成本效益比（ICER），意愿支付阈值为 100000 美元/QALY。
当策略相互比较时，ESG 在 I 级肥胖中具有成本效益（每 QALY 4105 美元）。SG 在 II 级肥胖（每 QALY 5883 美元）和 III 级肥胖（每 QALY 7821 美元）中具有成本效益。在 I/II/III 级肥胖中，SG 和 ESG 与 LI 相比具有成本效益。然而，司美格鲁肽与 LI 相比，在 I/II/III 级肥胖中不具有成本效益（ICER 分别为 508414 美元/QALY、420483 美元/QALY 和 350637 美元/QALY）。要使司美格鲁肽与 LI 相比具有成本效益，其每年的费用必须低于 7462 美元（III 级）、5847 美元（II 级）或 5149 美元（I 级）。要使司美格鲁肽与 ESG 相比具有成本效益，其每年的费用必须低于 1879 美元（III 级）、1204 美元（II 级）或 297 美元（I 级）。
具有成本效益的策略是：ESG 用于 I 级肥胖，SG 用于 II/III 级肥胖。司美格鲁肽可能具有成本效益，但需要大幅降低成本。鉴于药物治疗的潜在利用率更高，司美格鲁肽可能会降低与肥胖相关的死亡率。
