Division of Gastroenterology & Hepatology, Weill Cornell Medicine, 1283 York Avenue, 9 Floor, New York, NY, 10021, USA.
Department of Surgery, The University of Texas Health Science Center, Houston, TX, 77030, USA.
Obes Surg. 2024 Sep;34(9):3275-3284. doi: 10.1007/s11695-024-07324-z. Epub 2024 Aug 7.
Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT.
We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed.
In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons.
ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.
内镜下袖状胃切除术（ESG）是一种微创日间手术，MERIT 随机对照试验（RCT）已经证明，与单纯生活方式改变相比，它是一种有效且安全的减肥方法。我们旨在根据这项 RCT，从美国商业支付者的角度评估 ESG 在患有 II 类和 I 类肥胖合并糖尿病的成年人队列中的成本效益。
我们使用了 Markov 建模方法，采用 BMI 组健康状态和吸收性死亡状态。基线特征、效用、BMI 组转移概率和不良事件（AE）均基于 MERIT RCT 的患者水平数据进行了报道。死亡率通过将 BMI 特异性风险比应用于美国一般人群死亡率进行估算。我们使用基于 BMI 的健康状态效用来反映肥胖合并症的影响，并应用 ESG AE 的不效用。成本包括干预成本、AE 成本和基于 BMI 的年度直接医疗保健成本，以计入肥胖合并症相关的成本。假设愿意支付的阈值为每质量调整生命年（QALY）10 万美元。
在我们的 5 年时间范围内的基本案例分析中，ESG 与单纯生活方式改变相比具有成本效益，增量成本效益比为 23432 美元/QALY。在我们进行的所有敏感性分析中，ESG 仍然具有成本效益，并且在时间跨度更长的分析中具有优势。
ESG 是肥胖人群的一种具有成本效益的治疗选择，应该在商业健康计划中被视为临床合格患者的额外治疗选择。
