Cost-effectiveness of bariatric surgery for severely obese adults with diabetes.
Cost-effectiveness of bariatric surgery for severely obese adults with diabetes.
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DOI：
10.2337/dc10-0554
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发表时间：
2010-09
期刊：
影响因子：
16.2
通讯作者：
Couper S
中科院分区：
文献类型：
--
作者：
Hoerger TJ;Zhang P;Segel JE;Kahn HS;Barker LE;Couper S
使用经过验证的糖尿病成本效益模型来分析患有糖尿病的严重肥胖（BMI ≥35 kg/m2）成人的减肥手术的成本效益。我们扩大了疾病控制和预防中心的 RTI 糖尿病成本效益模型，将减肥手术纳入其中。在此模拟模型中，减肥手术可能会导致糖尿病缓解并减少其他危险因素，从而减少糖尿病并发症并提高生活质量 (QoL)。手术还与围手术期死亡率和随后的并发症相关，缓解期患者可能会复发糖尿病。我们分别估计了胃绕道手术相对于常规糖尿病护理和胃束带手术相对于常规糖尿病护理的成本、质量调整生命年（QALY）和成本效益。我们针对新诊断出患有糖尿病的严重肥胖者和已确诊患有糖尿病的严重肥胖者检查每种类型手术的成本效益。在所有分析中，减肥手术增加了 QALY 并增加了成本。对于新诊断和确诊糖尿病的严重肥胖患者，搭桥手术的成本效益比分别为 7,000 美元/QALY 和 12,000 美元/QALY。各组的束带手术的成本效益比分别为 11,000 美元/QALY 和 13,000 美元/QALY。在敏感性分析中，成本效益比受手术后体重指数损失直接提高生活质量的假设影响最大。我们的分析表明，胃绕道术和胃束带是降低严重肥胖成人糖尿病患者死亡率和糖尿病并发症的经济有效的方法。
To analyze the cost-effectiveness of bariatric surgery in severely obese (BMI ≥35 kg/m2) adults who have diabetes, using a validated diabetes cost-effectiveness model. We expanded the Centers for Disease Control and Prevention–RTI Diabetes Cost-Effectiveness Model to incorporate bariatric surgery. In this simulation model, bariatric surgery may lead to diabetes remission and reductions in other risk factors, which then lead to fewer diabetes complications and increased quality of life (QoL). Surgery is also associated with perioperative mortality and subsequent complications, and patients in remission may relapse to diabetes. We separately estimate the costs, quality-adjusted life-years (QALYs), and cost-effectiveness of gastric bypass surgery relative to usual diabetes care and of gastric banding surgery relative to usual diabetes care. We examine the cost-effectiveness of each type of surgery for severely obese individuals who are newly diagnosed with diabetes and for severely obese individuals with established diabetes. In all analyses, bariatric surgery increased QALYs and increased costs. Bypass surgery had cost-effectiveness ratios of $7,000/QALY and $12,000/QALY for severely obese patients with newly diagnosed and established diabetes, respectively. Banding surgery had cost-effectiveness ratios of $11,000/QALY and $13,000/QALY for the respective groups. In sensitivity analyses, the cost-effectiveness ratios were most affected by assumptions about the direct gain in QoL from BMI loss following surgery. Our analysis indicates that gastric bypass and gastric banding are cost-effective methods of reducing mortality and diabetes complications in severely obese adults with diabetes.
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影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
2.9
作者：
Ackroyd, Roger;Mouiel, Jean;Daoud, Frederic
通讯作者：
Daoud, Frederic
影响因子：
16.2
作者：
Keating, Catherine L.;Dixon, John B.;O'Brien, Paul E.
通讯作者：
O'Brien, Paul E.
影响因子：
3.1
作者：
Brancatisano, Anthony;Wahlroos, Sara;Brancatisano, Roy
通讯作者：
Brancatisano, Roy
影响因子：
158.5
作者：
Sjöström, L;Lindroos, AK;Wedel, H
通讯作者：
Wedel, H