Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity
Cost-effectiveness of Bariatric Surgery in Adolescents With Obesity
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DOI：
10.1001/jamasurg.2016.3640
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发表时间：
2017-02-01
期刊：
影响因子：
16.9
通讯作者：
Hur, Chin
中科院分区：
文献类型：
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作者：
Klebanoff, Matthew J.;Chhatwal, Jagpreet;Hur, Chin
严重肥胖影响了4%至6%的美国年轻人，并且患病率正在上升。减肥手术治疗严重肥胖的青少年正变得越来越普遍，但成本效益的数据有限。目的利用最近发表的青少年减肥手术纵向评估研究结果，评估青少年肥胖减肥手术的成本效益。设计、环境和患者构建状态转换模型，比较两种策略：不手术和减肥手术。在不进行手术的策略中，随着时间的推移，患者保持其初始体重指数（计算方法为体重（公斤）除以身高（米）的平方）。在减肥手术策略中，患者面临围手术期死亡率和并发症以及初始发病率的风险，但也经历了与减肥相关的长期生活质量改善。队列人口统计信息-纳入的228例患者中，平均（SD）年龄为17（1.6）岁，平均（范围）体重指数为53(34-88)，171例（75.0%）为女性手术相关结果，基本病例时间范围（3年）基于青少年减肥手术纵向评估研究的数据。进行了单向和概率敏感性分析。主要结果和测量方法：质量调整生命年（QALYs）、总成本（以美元计算，使用消费者价格指数调整为2015年的值）和增量成本效益比（ICERs）。每个QALY的支付意愿阈值为10万美元，用以评估成本效益。结果3年后，与不手术相比，手术导致了0.199个QALY的增加，增量成本为30747美元，每个QALY的不利ICER为154684美元。当临床研究结果外推到4年时，ICER降至每QALY 114078美元，并在5年后达到成本效益，ICER为每QALY 91032美元。结果在大多数单向和概率敏感性分析中是稳健的。结论和相关性减肥手术的初始成本和发病率很高。我们发现，如果在5年的时间范围内进行评估，手术可能是一种具有成本效益的治疗青少年严重肥胖的方法。我们的研究强调需要在青少年中进行长期临床试验，至少有5年的随访数据，以获取经济和生活质量的终点。
IMPORTANCE Severe obesity affects 4% to 6% of US youth and is increasing in prevalence. Bariatric surgery for the treatment of adolescents with severe obesity is becoming more common, but data on cost-effectiveness are limited.OBJECTIVE To assess the cost-effectiveness of bariatric surgery for adolescents with obesity using recently published results from the Teen-Longitudinal Assessment of Bariatric Surgery study.DESIGN, SETTING, AND PATIENTS A state-transition model was constructed to compare 2 strategies: no surgery and bariatric surgery. In the no surgery strategy, patients remained at their initial body mass index (calculated as weight in kilograms divided by height in meters squared) over time. In the bariatric surgery strategy, patients were subjected to risks of perioperative mortality and complications as well as initial morbidity but also experienced longer-term quality-of-life improvements associated with weight loss. Cohort demographic information-of the 228 patients included, the mean (SD) age was 17 (1.6) years, the mean (range) body mass index was 53 (34-88), and 171 (75.0%) were female-surgery-related outcomes, and base case time horizon (3 years) were based on data from the Teen-Longitudinal Assessment of Bariatric Surgery study. One-way and probabilistic sensitivity analyses were performed.MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), total costs (in US dollars adjusted to 2015-year values using the Consumer Price Index), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness.RESULTS After 3 years, surgery led to a gain of 0.199 QALYs compared with no surgery at an incremental cost of $ 30 747, yielding an unfavorable ICER of $ 154 684 per QALY. When the clinical study results were extrapolated to 4 years, the ICER decreased to $ 114 078 per QALY and became cost-effective by 5 years with an ICER of $ 91 032 per QALY. Outcomes were robust in most 1-way and probabilistic sensitivity analyses.CONCLUSIONS AND RELEVANCE Bariatric surgery incurs substantial initial cost and morbidity. We found that surgery could be a cost-effective treatment for adolescents with severe obesity if assessed over a time horizon of 5 years. Our study underscores the need for long-term clinical trials in adolescents with at least 5 years of follow-up data that capture financial and quality-of-life end points.