Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity.
Cost-effectiveness of laparoscopic gastric banding and bypass for morbid obesity.
复制标题
腹腔镜胃束带和绕道手术治疗病态肥胖的成本效益。
DOI：
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复制
发表时间：
2010
影响因子：
3.2
通讯作者：
M. Weinstein
中科院分区：
文献类型：
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作者：
J. Campbell;Lisa McGarry;S. Shikora;B. Hale;Jeffrey Lee;M. Weinstein
目的
评估腹腔镜可调节胃束带术（LAGB）和腹腔镜Roux-en-Y胃旁路术（LRYGB）治疗病态肥胖的成本效益。
研究设计
一个马尔可夫模型被开发来模拟体重减轻、健康后果和病态肥胖手术治疗的成本。该模型被用来估计增量成本效益比（ICER）的每质量调整生命年（QALY）获得的成本。
方法
手术有效性的估计值来自一项头对头随机对照试验的已发表结果。其他模型参数，包括并发症发生率，治疗费用，不良事件和肥胖，死亡率和效用，估计从已发表的文献和公开可用的数据库。成本（2006年美元）和季度利率每年贴现3%。
结果
在保守的假设下，与不治疗相比，LAGB和LRYGB都以更高的成本改善了健康结果。LAGB和LRYGB与未治疗相比的ICER均低于25，000美元/QALY。初始体重指数较高的个体的ICER较低，而老年人较高。男性的ICER普遍高于女性。敏感性分析表明，这些结果是稳健的模型参数和整体参数的不确定性的合理变化。LRYGB与LAGB的基础情况ICER低于每QALY增加25，000美元，但对模型假设高度敏感。
结论
LAGB和LRYGB都提供了显着的体重减轻，并且在传统接受的医疗干预阈值下与不治疗相比具有成本效益。
OBJECTIVE
To assess the cost-effectiveness of laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) as treatment for morbid obesity.
STUDY DESIGN
A Markov model was developed to simulate weight loss, health consequences, and costs for surgical treatment of morbid obesity. The model was used to estimate incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) gained.
METHODS
Estimates of procedure effectiveness were derived from published results of a head-to-head randomized controlled trial. Other model parameters, including complication rates, costs of treatment, adverse events and obesity, mortality rates, and utilities, were estimated from published literature and publicly available databases. Costs (2006 US dollars) and QALYs were discounted by 3% per annum.
RESULTS
Under conservative assumptions, both LAGB and LRYGB improved health outcomes, at a higher cost, compared with no treatment. ICERs for both LAGB and LRYGB versus no treatment were below $25,000 per QALY gained. ICERs were lower for individuals with higher initial body mass index and higher for older individuals. ICERs for men were generally higher than those of women. Sensitivity analyses showed these results to be robust to reasonable variation in model parameters and overall parameter uncertainty. Base-case ICERs for LRYGB versus LAGB were below $25,000 per QALY gained, but were highly sensitive to model assumptions.
CONCLUSION
Both LAGB and LRYGB provide significant weight loss and are cost-effective compared with no treatment at conventionally accepted thresholds for medical interventions.