Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK
Evaluating the cost-effectiveness of laparoscopic adjustable gastric banding versus standard medical management in obese patients with type 2 diabetes in the UK
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DOI：
10.1111/j.1463-1326.2012.01692.x
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发表时间：
2013-02-01
影响因子：
5.8
通讯作者：
Valentine, W. J.
中科院分区：
文献类型：
--
作者：
Pollock, R. F.;Muduma, G.;Valentine, W. J.
目的从英国医疗保健支付者的角度评价腹腔镜可调节胃束带术（LAGB）与标准医疗管理（SMM）在肥胖2型糖尿病患者中的成本效益。方法使用经验证的糖尿病计算机模型预测LAGB与SMM在肥胖2型糖尿病患者中的随机临床试验的结果。两年的随访数据，从试验预计超过40年的时间范围和成本效益进行了评估，从国家卫生服务的角度。未来的成本和临床结果以每年3.5%的折扣率进行贴现，所有成本均以2010年英镑报告。进行了一系列敏感性分析。结果LAGB与HbA1c、收缩压、体重指数和血脂浓度的改善相关，从而导致折扣预期寿命显着增加（增加0.64？年）和质量调整的预期寿命（增加0.92质量调整的生命年，Qs），并减少糖尿病并发症的发生率相对于SMM。LAGB组的治疗费用增加了4552英镑（GBP），但这部分被所有模拟糖尿病并发症发生率降低所节省的费用所抵消。在基础案例中，每QALY 3602英镑的增量成本效益比远低于英国环境中通常引用的支付意愿阈值。结论：根据最近的随机对照试验数据，从医疗保健支付者的角度来看，LAGB可能被认为是具有成本效益的，与SMM相比，在英国设置的2型糖尿病患者的肥胖。
Aim To evaluate the cost-effectiveness of laparoscopic adjustable gastric banding (LAGB) versus standard medical management (SMM) in obese patients with type 2 diabetes from a UK healthcare payer perspective. Methods A validated computer model of diabetes was used to project outcomes reported from a randomized clinical trial of LAGB versus SMM in obese patients with type 2 diabetes. Two-year follow-up data from the trial were projected over a 40-year time horizon and cost-effectiveness was assessed from the perspective of the National Health Service. Future costs and clinical outcomes were discounted at 3.5% annually and all costs were reported in 2010 pounds sterling. A series of sensitivity analyses were performed. Results LAGB was associated with benefits in HbA1c, systolic blood pressure, body mass index and serum lipid concentrations, which led to significant increases in discounted life expectancy (an increase of 0.64?years) and quality-adjusted life expectancy (an increase of 0.92 quality-adjusted life years, QALYs) and reduced incidence of diabetes complications relative to SMM. Treatment costs in the LAGB arm increased by 4552 Great British Pounds (GBP), but this was partially offset by cost savings resulting from a reduction in the incidence of all modelled diabetes complications. The incremental cost-effectiveness ratio of GBP 3602 per QALY in the base case fell well below commonly quoted willingness-to-pay thresholds in the UK setting. Conclusions On the basis of data from a recent randomized controlled trial, LAGB is likely to be considered cost-effective from the healthcare payer perspective when compared with SMM of obesity in patients with type 2 diabetes in the UK setting.