Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.
Comparison of Ambulatory Health Care Costs and Use Associated With Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy.
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DOI：
10.1001/jamanetworkopen.2022.9661
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发表时间：
2022-05-02
影响因子：
13.8
通讯作者：
Wharam, James F.
中科院分区：
文献类型：
--
作者：
Lewis, Kristina H.;Argetsinger, Stephanie;Arterburn, David E.;Clemenzi, Jenna;Zhang, Fang;Kamusiime, Ronald;Fernandez, Adolfo;Ross-Degnan, Dennis;Wharam, James F.
袖状胃切除术（SG）与Roux-en-Y胃旁路术（RYGB）与患者门诊医疗保健使用和费用的比较关系是什么？在这项包括6300名患者的比较有效性研究中，SG和RYGB治疗后长达4年的总门诊费用相似。然而，RYGB与心脏代谢疾病处方的减少有关，而SG与术后专家就诊和实验室检查减少有关。这些结果表明，与SG相比，RYGB后对心脏代谢药物的需求较少，但在这种更具侵入性的手术后，对术后监测的需求更大。这项有效性比较研究评估了袖状胃切除术和Roux-en-Y胃旁路术与术后4年门诊医疗费用和使用的相关性。比较当代减肥手术类型的研究可以促进有兴趣减少他们的医疗保健访问频率和依赖处方药的患者的程序选择。比较袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）与门诊医疗保健费用的相关性，并在术后使用长达4年。这项比较有效性研究包括接受减肥手术的患者，年龄在18至64岁之间，术前至少有24个月的入组数据，术后至少有12个月的入组数据，使用了一项回顾性中断时间序列与一个对照组。数据代表2006年1月至2017年6月的保险索赔，分析于2021年9月完成。数据来自美国商业和医疗保险优势索赔数据库。队列的特征包括基线体重指数分类、糖尿病状态、基线门诊护理费用、美国地区和手术年份。SG或RYGB，基于程序代码。年度门诊医疗保健成本以及成本和使用的子类型，包括处方、办公室就诊、实验室就诊和放射科。匹配队列包括3049例接受SG的患者和3251例接受RYGB的患者，平均（SD）年龄为45.2（10.0）岁; 4820例（77%）为女性。在符合4年随访条件的患者中，SG（514例患者）和RYGB（643例患者）的完整随访率分别为37%和38%。在所有随访年中，SG和RYGB在总门诊费用、门诊费用或放射学费用方面没有显著差异。在第4年，接受SG的患者的处方费用显著高于接受RYGB旁路术的患者（每例患者每年852.8美元; 95% CI：每例患者每年395.6 - 1310.0美元），每年使用更多的心脏代谢药物（例如，第4年：42.5%; 95% CI，13.7%-71.2%）。相比之下，在术后早期，接受SG的患者的专科就诊相对较少（例如，第1年：-7.2%; 95% CI，-14.3%至0.2%），实验室费用较低（例如，第1年：-118.9美元/患者/年; 95% CI，-220.2美元/患者/年至-17.5美元/患者/年）。尽管临床研究显示，与SG相比，RYGB的体重减轻和合并症改善更大，但本研究发现，SG和RYGB治疗后长达4年的总门诊费用没有差异。这些发现可能反映了在接受RYGB的患者中，心脏代谢健康的更大改善和额外的手术相关护理之间的权衡。随访时间较长的研究可以确定与SG相比，RYGB更大的持续体重减轻最终是否会导致更低的成本。
What are the comparative associations of sleeve gastrectomy (SG) vs Roux-en-Y gastric bypass (RYGB) with patients’ ambulatory health care use and costs? In this comparative effectiveness study that included 6300 patients, total ambulatory costs were similar for as long as 4 years following SG and RYGB. However, RYGB was associated with greater reductions in prescriptions for cardiometabolic disease, while SG was associated with fewer specialist visits and laboratory tests after surgery. These findings suggest that lesser need for cardiometabolic medications following RYGB vs SG may be counterbalanced by a greater need for postsurgical monitoring after this more invasive procedure. This comparative effectiveness study evaluates the associations of sleeve gastrectomy and Roux-en-Y gastric bypass with ambulatory health care costs and use for 4 years after surgery. Studies comparing contemporary bariatric surgical types could facilitate procedure selection for patients interested in reducing their frequency of health care visits and reliance on prescription drugs. To compare the association of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with ambulatory health care costs and use for as long as 4 years after surgery. This comparative effectiveness study, which included patients undergoing bariatric surgery who were aged 18 to 64 years with at least 24 months of enrollment data before surgery and 12 months of enrollment data after surgery, used a retrospective interrupted time series with a comparison group. Data represent insurance claims dated January 2006 to June 2017, with analyses completed in September 2021. Data were collected from US commercial and Medicare Advantage claims database. Cohorts were matched on characteristics including baseline body mass index category, diabetes status, baseline ambulatory care costs, region of the United States, and year of surgery. SG or RYGB, based on procedure codes. Annual ambulatory health care costs, and subtypes of cost and use including prescriptions, office visits, laboratory encounters, and radiology. Matched cohorts included 3049 patients who underwent SG and 3251 patients who underwent RYGB, with a mean (SD) age of 45.2 (10.0) years; 4820 (77%) were women. Full follow-up was 37% for SG (514 patients) and 38% for RYGB (643 patients) among those eligible for 4-year follow-up. There were no significant differences between SG and RYGB in total ambulatory costs, office visit costs, or radiology costs in all follow-up years. Patients who underwent SG had significantly higher prescription costs than those who underwent RYGB bypass in year 4 ($852.8 per patient per year; 95% CI: $395.6-$1310.0 per patient per year) with more cardiometabolic medication fills in each year (eg, year 4: 42.5%; 95% CI, 13.7%-71.2%). In contrast, early after surgery, patients who underwent SG had relatively fewer specialist visits (eg, year 1: −7.2%; 95% CI, −14.3% to −0.2%) and lower laboratory costs (eg, year 1: −$118.9 per patient per year; 95% CI, −$220.2 to −$17.5 per patient per year). Despite clinical studies showing greater weight loss and comorbidity improvement with RYGB vs SG, this study found no difference in total ambulatory costs for as long as 4 years after SG and RYGB. These findings may reflect the trade-off between greater improvements in cardiometabolic health and additional surgery-related care among patients undergoing RYGB. Studies with longer follow-up time could determine whether greater sustained weight loss from RYGB eventually results in lower costs compared with SG.
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影响因子：
37.8
作者：
Jensen MD;Ryan DH;Apovian CM;Ard JD;Comuzzie AG;Donato KA;Hu FB;Hubbard VS;Jakicic JM;Kushner RF;Loria CM;Millen BE;Nonas CA;Pi-Sunyer FX;Stevens J;Stevens VJ;Wadden TA;Wolfe BM;Yanovski SZ;Jordan HS;Kendall KA;Lux LJ;Mentor-Marcel R;Morgan LC;Trisolini MG;Wnek J;Anderson JL;Halperin JL;Albert NM;Bozkurt B;Brindis RG;Curtis LH;DeMets D;Hochman JS;Kovacs RJ;Ohman EM;Pressler SJ;Sellke FW;Shen WK;Smith SC Jr;Tomaselli GF;American College of Cardiology/American Heart Association Task Force on Practice Guidelines;Obesity Society
通讯作者：
Obesity Society
影响因子：
13.8
作者：
Lewis, Kristina H.;Arterburn, David E.;Wharam, James F.
通讯作者：
Wharam, James F.
DOI：
10.1016/j.soard.2020.08.035
发表时间：
2021-01
期刊：
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery
影响因子：
--
作者：
Lewis KH;Callaway K;Argetsinger S;Wallace J;Arterburn DE;Zhang F;Fernandez A;Ross-Degnan D;Dimick JB;Wharam JF
通讯作者：
Wharam JF
影响因子：
--
作者：
Maciejewski, Matthew L.;Livingston, Edward H.;Arterburn, David E.
通讯作者：
Arterburn, David E.
影响因子：
3.1
作者：
English, Wayne J.;DeMaria, Eric J.;Morton, John M.
通讯作者：
Morton, John M.