Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Transplant. 2024 Dec;24(12):2212-2224. doi: 10.1016/j.ajt.2024.07.024. Epub 2024 Jul 30.
Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness, risk profiles, and costs make strategy choices challenging. To aid decision-making, we used a Markov model to examine the cost-effectiveness of different WL strategies over a 10-year horizon. A target WL of 15% of total body weight was used for the base case scenario, and we compared these strategies to a "liberal" KT strategy of transplanting candidates with obesity. Outcomes included costs (2023 US dollars), quality-adjusted life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies, bariatric surgery was the most effective and cost the least, whereas lifestyle modification had the highest cumulative costs and was the least effective. Compared to liberal KT, bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes and cost-effectiveness.
新型抗肥胖药物，特别是胰高血糖素样肽-1 受体激动剂（GLP-1RAs），为肥胖的肾移植（KT）候选者提供了除生活方式改变和减重手术之外的减肥（WL）选择。然而，由于疗效、风险状况和成本各不相同，使得策略选择具有挑战性。为了帮助决策，我们使用马尔可夫模型在 10 年的时间内检查了不同 WL 策略的成本效益。以 15%的总体重为目标 WL 作为基本情况的方案，我们将这些策略与肥胖候选者的“宽松”KT 策略进行了比较。结果包括成本（2023 年美元）、质量调整生命年和增量成本效益比。在分析中，宽松的 KT 策略优于生活方式改变和 GLP-1RAs。在 WL 策略中，减重手术最有效且成本最低，而生活方式改变则具有最高的累积成本，效果最差。与宽松的 KT 相比，减重手术每获得一个质量调整生命年的成本为 45859 美元。只有当药物成本低于每年 5000 美元（基本成本为 12077 美元）时，GLP-1RAs 才优于减重手术。总之，对于肥胖的 KT 候选者，基于结果和成本效益，宽松的 KT 策略和减重手术优于单独的生活方式改变和 GLP-1RAs。
