Vannucci Maria, Riva Pietro, Vix Michel, Mutter Didier, Keller Deborah S, Perretta Silvana
General surgery department, University of Torino, Turin, Italy.
Institute of Image Guided Surgery (IHU), Strasbourg, France.
Surg Endosc. 2025 Feb;39(2):1333-1340. doi: 10.1007/s00464-024-11487-2. Epub 2025 Jan 9.
Obesity is a worldwide epidemic, with up to 17% of French population affected. European guidelines recommend surgical management at specific weight and comorbidity level; however, less than 2% of eligible patients undergo surgical bariatric interventions. To extend the benefits of bariatric interventions to the untreated population with obesity, endoscopic techniques such as endoscopic sleeve gastroplasty (ESG) have been developed. Analysis of costs and long-term benefits of ESG across stakeholders is needed. This work aimed to assess the healthcare economic and outcomes for ESG in the French healthcare system.
A cost-utility analysis study was conducted to evaluate class II obesity patients, stratified into ESG and lifestyle modifications or lifestyle modifications alone groups. Health benefits were measured as quality-adjusted life years (QALY) and costs benefits expressed as incremental cost-effectiveness ratio (ICER). A 6-state Markov model was used and base case scenario analysis was used to assess ESG benefits against lifestyle modifications only. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis were performed to evaluate uncertainty on health care interventions and worse case scenarios, respectively.
ESG population from the France center included 59 patients, lifestyle modification group was drawn from the MERIT cohort. The base case scenario showed higher costs for ESG procedure compared to lifestyle modifications alone; however, gain in terms of QALY (+ 1,3) is observed maintaining ICER below the set threshold. Also OWSA and probabilistic analysis confirmed ESG cost-effectiveness. OWSA allowed identification of ICER-influencing factors; probabilistic sensitivity analysis confirmed ESG to be cost-effective in 99.29% of iterations.
ESG is cost-effective in the French healthcare system. Its potential to reach an untreated portion of the population living with obesity should prompt its uptake into clinical practice. The results of this study should sustain ESG implementation throughout France and possible integration of its reimbursement by the public healthcare system.
肥胖是一种全球性的流行病，法国高达17%的人口受其影响。欧洲指南建议在特定体重和合并症水平下进行手术治疗；然而，只有不到2%的符合条件的患者接受减肥手术干预。为了将减肥手术干预的益处扩展到未接受治疗的肥胖人群，已经开发了诸如内镜袖状胃成形术（ESG）等内镜技术。需要分析ESG在各利益相关者中的成本和长期效益。这项工作旨在评估法国医疗保健系统中ESG的医疗经济和效果。
进行了一项成本效用分析研究，以评估II类肥胖患者，分为ESG组和生活方式改变组或仅生活方式改变组。健康效益以质量调整生命年（QALY）衡量，成本效益以增量成本效益比（ICER）表示。使用了一个6状态马尔可夫模型，并采用基本情景分析来评估ESG相对于仅生活方式改变的益处。分别进行单向敏感性分析（OWSA）和概率敏感性分析，以评估医疗保健干预措施的不确定性和最坏情况。
法国中心的ESG人群包括59名患者，生活方式改变组来自MERIT队列。基本情景显示，与仅生活方式改变相比，ESG手术的成本更高；然而，观察到QALY有所增加（+1.3），ICER保持在设定阈值以下。OWSA和概率分析也证实了ESG的成本效益。OWSA确定了影响ICER的因素；概率敏感性分析证实，在99.29%的迭代中，ESG具有成本效益。
在法国医疗保健系统中，ESG具有成本效益。其覆盖未接受治疗的肥胖人群的潜力应促使其被纳入临床实践。本研究结果应支持ESG在法国的实施，并可能将其纳入公共医疗保健系统的报销范围。
