Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort.

Abstract

OBJECTIVES:

To find whether Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery was cost effective compared to conventional medical management (CMM) in Chinese patients with type 2 Diabetes(T2D) and obesity with a body mass index (BMI) ≥27.5 kg/m2 in four years.

METHODS:

A total of 106 obese T2D individuals who underwent RYGB and 106 T2D patients treated with CMM were enrolled from three academic medical centers. Total health related costs, Glycated Hemoglobin A1c (A1C) and BMI was recorded. Cost-Utility Analysis (CUA) was used. Utility values according to results of A1c were obtained from published studies.

RESULTS:

Improvements were observed in A1C (8.6% at baseline to 6.2% in the first year, p < 0.001) and BMI (30.7 kg/m2 at baseline to 24.3 kg/m2 in the first year, p < 0.001), and the effect lasted for 4 years after RYGB. In the CMM group, A1C fluctuated in four years. The health utility for RYGB group scores 3.756, whereas CMM group scores 3.594 in four years. The total healthcare costs decreased sharply from the second year after RYGB ($8,483 [¥52,596] in the first year to $672[¥4,164] in the second year, p < 0.001) and maintained for 3 years. In the CMM group, the total healthcare costs changed without significance. RYGB costs US$19,359 (¥125,836) per quality-adjusted life years (QALY) gained (incremental cost-utility ratio [ICUR]) compared to CMM, which was lower than a willingness-to-pay (WTP) of $20,277/QALY.

CONCLUSIONS:

Compared to CMM, RYGB is cost-effective for Chinese patients with type 2 diabetes and obesity 4 years after operation.

• Authors: Yinfang Tu, Liang Wang, Li Wei, Youhao Xu, Xiaodong Han, Junfeng Han, Haoyong Yu, Chao Zheng, Yuqian Bao, Weiping Jia
• Journal: Obesity surgery (Obes Surg) Vol. 29 Issue 12 Pg. 3978-3986 (12 2019) ISSN: 1708-0428 [Electronic] United States
• PMID: 31338737 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Aged
• Body Mass Index
• China
• Cost-Benefit Analysis
• Diabetes Mellitus, Type 2 (complications, economics, surgery, therapy)
• Female
• Follow-Up Studies
• Gastric Bypass (economics, methods)
• Health Care Costs (statistics & numerical data)
• Humans
• Laparoscopy (economics, methods)
• Male
• Middle Aged
• Obesity (complications, economics, surgery, therapy)
• Quality-Adjusted Life Years
• Treatment Outcome
• Young Adult