Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study
Health-care costs over 15 years after bariatric surgery for patients with different baseline glucose status: results from the Swedish Obese Subjects study
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DOI：
10.1016/s2213-8587(15)00290-9
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发表时间：
2015-11-01
影响因子：
44.5
通讯作者：
Carlsson, Lena M. S.
中科院分区：
文献类型：
--
作者：
Keating, Catherine;Neovius, Martin;Carlsson, Lena M. S.
背景 减肥手术可以预防和诱导许多患者缓解 2 型糖尿病。术前血糖状况对长期医疗费用的影响尚不清楚。我们的目的是评估接受常规治疗或接受减肥手术且在干预前患有正常血糖、糖尿病前期或 2 型糖尿病的肥胖患者 15 年来的医疗费用。方法瑞典肥胖受试者 (SOS) 研究是一项前瞻性研究，对象为接受减肥手术的成年人和同期接受常规治疗的对照对照（年龄 37-60 岁；男性 BMI ≥ 34，女性 BMI ≥ 38）招募自瑞典 25 个外科部门和 480 个初级卫生保健中心。两个研究组的排除标准相同，均为既往胃部或减肥手术、近期恶性肿瘤或心肌梗塞、特定精神疾病以及其他减肥手术禁忌症。常规治疗范围从不治疗到生活方式干预和行为改变。在这项研究中，我们通过问卷调查和全国瑞典处方药登记册检索了 SOS 研究中患者的处方药费用。我们从瑞典国家患者登记处检索了住院和门诊就诊的数据。我们对与注册数据相关的样本进行了长达 15 年的跟踪。我们调整了基线特征的平均差异。分析是按意向治疗进行的。 SOS研究已在ClinicalTrials.gov注册，编号为NCT01479452。调查结果 1987年9月1日至2001年1月31日期间，2010名接受减肥手术的成年人和2037名接受常规治疗的成年人被纳入SOS研究。在这项研究中，我们对 4030 名患者进行了随访（其中 2836 名患者血糖正常；591 名患者患有糖尿病前期；603 名患者患有糖尿病）。正常血糖亚组中手术组和常规治疗组的药物费用没有差异（手术 10511 美元 vs 常规治疗 10680 美元；调整后平均差 - 225 美元 [95% CI -2080 至 1631]；p=0.812），但糖尿病前期手术组的药物费用较低（10194 美元 vs 13186 美元；-3329 美元 [-5722]）至 -937]；p=0.007）和糖尿病（14346 美元 vs 19511 美元；-5487 美元[-7925 至 -3049]；p
Background Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention.Methods The Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of >= 34 in men and >= 38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452.Findings Between Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10511 vs conventional treatment $10680; adjusted mean difference -$225 [95% CI -2080 to 1631]; p=0.812), but were lower in the surgery group in the prediabetes ($10194 vs $13186; -$3329 [-5722 to -937]; p=0.007) and diabetes ($14346 vs $19511; -$5487 [-7925 to -3049]; p