Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity.
Cost-Effectiveness of Weight-Loss Interventions Prior to Total Knee Replacement for Patients With Class III Obesity.
复制标题
III 级肥胖患者全膝关节置换术前减肥干预的成本效益。
DOI：
10.1002/acr.25044
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发表时间：
2023
影响因子：
4.7
通讯作者：
Losina,Elena
中科院分区：
文献类型：
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作者：
Kostic,AleksandraM;Leifer,ValiaP;Selzer,Faith;Hunter,DavidJ;Paltiel,ADavid;Chen,AntoniaF;Robinson,MalcolmK;Neogi,Tuhina;Collins,JamieE;Messier,StephenP;Edwards,RobertR;Katz,JeffreyN;Losina,Elena
目的Ⅲ类肥胖（体重指数> 40 kg/m2）患者行全膝关节置换术（TKR）后并发症发生率高，建议减重。我们的目的是确定Roux‐en‐Y胃旁路术（RYGB）、腹腔镜袖状胃切除术（LSG）和生活方式非手术减肥（LNSWL）干预在考虑TKR的III级肥胖膝关节骨关节炎患者中的成本效益。方法使用Osteoarthritis Policy模型和已发表文献中的数据推导出RYGB、LSG、LNSWL和TKR的模型输入，我们评估了考虑TKR的III类肥胖患者减肥干预的长期临床获益、成本和成本效益。我们从医疗保健部门的角度评估了以下策略：1）无体重减轻/无TKR，2）立即TKR，3）LNSWL，4）LSG和5）RYGB。每种减肥策略后，每年进行TKR再评价。主要结局是成本、质量调整预期寿命（QALE）和增量成本-效果比（ICER），每年折扣3%。我们进行了确定性和概率敏感性分析，以检查输入不确定性的结论的鲁棒性。结果与未干预相比，LSG使QALE增加了1.64个质量调整生命年（QALY），终身医疗成本增加了17，347，导致ICER为10，600/QALY。RYGB使QALE增加0.22，成本增加4，607，导致ICER为20，500/QALY。相对于即刻TKR，LSG和RYGB延迟并降低了TKR的利用率。在概率敏感性分析中，RYGB在50，000/QALY. Conclusionforpatients with classIII obesityabnormalizing TKR的支付意愿阈值下，在67%的迭代中具有成本效益，RYGB提供了良好的价值，而没有任何损失的立即TKR在经济上并不有效。
Objective Class III obesity (body mass index> 40 kg/m2) is associated with higher complications following total knee replacement (TKR), and weight loss is recommended. We aimed to establish the cost‐effectiveness of Roux‐en‐Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG), and lifestyle nonsurgical weight loss (LNSWL) interventions in knee osteoarthritis patients with class III obesity considering TKR. Methods Using the Osteoarthritis Policy model and data from published literature to derive model inputs for RYGB, LSG, LNSWL, and TKR, we assessed the long‐term clinical benefits, costs, and cost‐effectiveness of weight‐loss interventions for patients with class III obesity considering TKR. We assessed the following strategies with a health care sector perspective: 1) no weight loss/no TKR, 2) immediate TKR, 3) LNSWL, 4) LSG, and 5) RYGB. Each weight‐loss strategy was followed by annual TKR reevaluation. Primary outcomes were cost, quality‐adjusted life expectancy (QALE), and incremental cost‐effectiveness ratios (ICERs), discounted at 3% per year. We conducted deterministic and probabilistic sensitivity analyses to examine the robustness of conclusions to input uncertainty. Results LSG increased QALE by 1.64 quality‐adjusted life‐years (QALYs) and lifetime medical costs by 17,347comparedtonointervention,leadingtoanICERof 10,600/QALY. RYGB increased QALE by 0.22 and costs by 4,607beyondLSG,resultinginanICERof 20,500/QALY. Relative to immediate TKR, LSG and RYGB delayed and decreased TKR utilization. In the probabilistic sensitivity analysis, RYGB was cost‐effective in 67% of iterations at a willingness‐to‐pay threshold of 50,000/QALY.ConclusionForpatientswithclassIIIobesityconsideringTKR,RYGBprovidesgoodvaluewhileimmediateTKRwithoutweightlossisnoteconomicallyefficient.