Gastric Bypass is a Cost-Saving Procedure: Results from a Comprehensive Markov Model
Gastric Bypass is a Cost-Saving Procedure: Results from a Comprehensive Markov Model
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DOI：
10.1007/s11695-012-0816-8
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发表时间：
2013-04-01
期刊：
影响因子：
2.9
通讯作者：
Costa-Maia, Jose
中科院分区：
文献类型：
--
作者：
Faria, Gil R.;Preto, John R.;Costa-Maia, Jose
在工业化国家，肥胖是一个日益严重的公共卫生问题，它直接和间接地造成了近10%的卫生支出。减肥手术是最好的治疗方法，然而，与重要的经济支出相关。因此，对可用的手术选择进行成本效益分析是至关重要的。我们为三种不同的策略开发了马尔可夫模型：最佳医疗管理、胃束带和胃旁路。马尔可夫模型的建立是为了评估几种与肥胖相关的合并症的影响。结果来源于病态肥胖患者的代表性人群，并对无合并症的患者、糖尿病患者、不同年龄和体重指数（BMI）组进行亚组分析。从社会角度考虑终身成本，进行了成本效益分析。胃旁路治疗是一种主要的治疗策略，可以显著降低患者的终生成本，增加患者的质量调整生命年（QALYs）。与最佳医疗管理相比，在全球BMI为> 35 kg/m(2)的患者人群中，胃旁路治疗可额外获得1.9个QALYs，平均每位患者节省13,244a（非体征）。较年轻的患者、BMI在40 - 50 kg/m(2)之间的患者以及无肥胖相关疾病的患者在成本效益方面获益较大。胃旁路手术提高了经质量调整的生存率，节省了卫生系统的资源。因此，这可能是控制不断增加的卫生支出的一个重要过程。
Obesity is a growing public health problem in industrialized countries and is directly and indirectly responsible for almost 10 % of all health expenditures. Bariatric surgery is the best available treatment, however, associated with important economical expenditures. So, cost-effectiveness analysis of the available surgical options is paramount.We developed a Markov model for three different strategies: best medical management, gastric band, and gastric bypass. The Markov model was constructed to allow for the evaluation of the impact of several obesity-related comorbidities. The results were derived for a representative population of morbidly obese patients, and subgroup analyses were performed for patients without comorbidities, patients with diabetes mellitus, different age, and body mass index (BMI) groups. Cost-effectiveness analysis was performed accounting for lifetime costs and from a societal perspective.Gastric bypass is a dominant strategy, rendering a significant decrease in lifetime costs and increase in quality-adjusted life years (QALYs). Comparing with the best medical management, in the global population of patients with a BMI of > 35 kg/m(2), gastric bypass renders 1.9 extra QALYs and saves on average 13,244a,not sign per patient. Younger patients, patients with a BMI between 40 and 50 kg/m(2), and patients without obesity-related diseases are the ones with a bigger benefit in terms of cost effectiveness.Gastric bypass surgery increases quality-adjusted survival and saves resources to health systems. As such, it can be an important process to control the ever-increasing health expenditure.