Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries
Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries
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DOI：
10.1381/096089206778870067
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发表时间：
2006-11-01
期刊：
影响因子：
2.9
通讯作者：
Daoud, Frederic
中科院分区：
文献类型：
--
作者：
Ackroyd, Roger;Mouiel, Jean;Daoud, Frederic
背景资料：我们的目的是建立一个支付者视角的成本效益和预算影响（BI）模型，可调节胃束带术（AGB）和胃旁路术（GBP）与传统治疗（CT）的患者BMI >= 35 kg/m2（2）和2型糖尿病T2DM.Methods：临床证据来自文献和患者报告的EQ-5D评分，BMI和T2 DM状态来自HODaR。AGB、GBP和CT的资源利用数据来自引用的出版物，以反映2005年的实践。每个国家的CT基于HTA报告中的描述或基于共同作者的当前实践经验。单位成本是从出版的来源获得的，如果有的话，或从共同作者的机构。一个确定性的算法与成本和效用贴现，使选择的输入独立的整个时间范围内为每3个治疗，并包括平均BMI，资源和单位costs.Results的金额：基本情况下的时间范围是5年，每年的贴现率为公用事业和成本为3.5%。与CT相比，GBP产生了+80.8 kg/m2.年，+2.6无T2 DM年和+1.34 Qs。AGB产生了+57.8千克/平方米.年，+2.5无T2 DM年和+1.03 Qs。在德国和法国，GBP和AGB都降低了成本，因此与CT相比，在ICER方面占主导地位。结论：在德国和法国，对于BMI >= 35 kg/m2的2型糖尿病患者，AGB和GBP在5年随访时可有效节约成本，在英国，对于中等BMI的患者，AGB和GBP与CT相比具有成本效益。
Background: We aimed to establish a payer-perspective cost-effectiveness and budget impact (BI) model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs conventional treatment (CT) in patients with BMI >= 35 kg/m(2) and type-2 diabetes T2DM, in Germany, UK and France.Methods: Clinical evidence was obtained from literature and patient-reported EQ-5D scores given BMI and T2DM status from HODaR. Resource utilization data in AGB, GBP and CT were obtained from quoted publications so as to reflect practice in 2005. CT in each country was based on descriptions in HTA reports or based on co-authors' experience of current practice. Unit costs were obtained from published sources when available, or from co-authors' institutions. A deterministic algorithm with cost and utility discounting, enabled selection of inputs independently throughout the time scope for each of the 3 treatments, and included mean BMI, amounts of resources and unit costs.Results: The base case time-scope was 5 years, and the annual discount rate for utilities and costs was 3.5%. Compared to CT, GBP yielded +80.8 kg/m(2).years, +2.6 T2DM-free-years and +1.34 QALYs. AGB yielded +57.8 kg/m(2).years, +2.5 T2DM-free-years and +1.03 QALYs. In Germany and France, both GBP and AGB yielded a cost decrease, and were thus dominant in terms of ICER compared to CT. In the UK, GBP and AGB yielded a cost increase, but were cost-effective.Conclusion: In patients with T2DM and BMI >= 35 kg/m(2), AGB and GBP are effective at 5-year follow-up in cost-saving in Germany and France, and are cost-effective in the UK with a moderate BI vs CT.