Long-term Costs and Return on Investment for Bariatric Surgery

减肥手术的长期成本和投资回报

• 批准号: 10218157
• 负责人: David Eric Arterburn
• 金额: $ 68.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-17 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10218157
• 关键词: Accounting; Address; Adult; Attitude; Bariatrics; Body Weight decreased; Caring; Clinical; Cost Savings; Data; Economics; Expenditure; Gastrectomy; Gastric Bypass; Gastroplasty; Head; Health; Health Care Costs; Health Expenditures; Heterogeneity; Insurance Carriers; Insurance Coverage; Investments; Knowledge; Medical; Medicare; Methods; Morbid Obesity; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Operative Surgical Procedures; Patients; Physicians; Privatization; Procedures; Quality-Adjusted Life Years; Research; Resources; Risk; Subgroup; Time; Work; bariatric surgery; budget impact; care costs; clinically significant; cohort; cost; cost effective; economic impact; economic outcome; effective therapy; follow-up; indexing; patient subsets; treatment effect; trend; uptake

ABSTRACT Bariatric surgery is the most effective treatment for severe obesity, yet only 1-2% of eligible patients undergo surgery annually. This low rate of bariatric surgery uptake persists despite strong evidence of the high cost of severe obesity and the superiority of bariatric procedures in inducing clinically significant and sustained weight loss, prolonged survival, and major improvements in obesity-related health conditions [i.e., type 2 diabetes (T2DM)] when compared to usual medical care. Barriers to use of bariatric surgery include patient and physician knowledge and attitudes towards these procedures; lack of resources for non-surgical treatment of severe obesity; and high patient costs arising from inadequate insurance coverage. Inadequate coverage and significant pre-surgical requirements is common among private insurers despite Medicare providing full coverage for bariatric procedures for >20 years and evidence that bariatric surgery is cost-effective at <$50,000/QALY. This continued gap in coverage of bariatric surgery appears to be driven by concerns about the long-term costs of complications and surgery’s large potential budget impact, since ~15% of U.S. adults are eligible for bariatric surgery and the cost per procedure is high ($20-30,000/procedure). As a result, payers may require evidence that bariatric surgery is cost-saving before providing broader coverage. There are four major gaps in the economic evidence that are barriers to expansion of private insurance coverage for bariatric surgery. We propose to address these evidence gaps by comparing the 5- and 10-year expenditures of ~30,000 patients who previously underwent the two most common bariatric procedures (SG and RYGB) and a large cohort (~90,000) of rigorously matched non-surgical patients with severe obesity from years 2005-2019 with follow-up through 2021. Over 5,000 surgical patients and 15,000 nonsurgical patients with index dates before 2012 will have data at 10 years or beyond, making this the largest economic study to date and the study with the longest follow-up. We propose to address three aims: Aim 1: Compare 5- and 10-year changes in total costs of health care among patients undergoing SG and RYGB versus matched non-surgical patients with severe obesity. Aim 2: Examine heterogeneity of the effect of surgery on costs to understand whether there are clinical subgroups of patients with severe obesity who have more favorable post-surgical cost trajectories. • Aim 2a: We will examine heterogeneity among all surgical patients and matched nonsurgical patients. • Aim 2b: We will examine heterogeneity among surgical patients with T2DM and their matches. Aim 3: Estimate time to break-even for each subgroup identified in aim 2 to identify the return-on-investment over a 5- to 10-year time frame after accounting for the initial costs of surgery.

抽象的 减肥手术是治疗严重肥胖最有效的方法，但只有 1-2% 的患者符合资格 每年接受手术。尽管有强有力的证据表明减肥手术的接受率很高，但这种低接受率仍然存在 严重肥胖的成本以及减肥手术在诱导具有临床意义和持续性的方面的优越性 体重减轻、延长生存期以及与肥胖相关的健康状况（即 2 型肥胖）的重大改善 糖尿病（T2DM）]与常规医疗护理相比。使用减肥手术的障碍包括患者和 医生对这些程序的知识和态度；缺乏非手术治疗的资源 严重肥胖；保险范围不足而导致的高额患者费用。覆盖范围不足和 尽管医疗保险提供全面承保，但私人保险公司普遍存在大量术前要求 减肥手术超过 20 年，有证据表明减肥手术的成本效益低于 50,000 美元/QALY。 减肥手术覆盖范围的持续差距似乎是由于对长期成本的担忧造成的 并发症和手术的巨大潜在预算影响，因为约 15% 的美国成年人有资格接受减肥治疗 手术且每次手术的费用很高（每次手术 20-30,000 美元）。因此，付款人可能需要证据 减肥手术在提供更广泛的覆盖范围之前可以节省成本。 经济证据中存在四大缺陷，阻碍了私人保险的扩张 减肥手术的承保范围。我们建议通过比较 5 年和 10 年的数据来解决这些证据差距 约 30,000 名之前接受过两种最常见减肥手术（SG 和 RYGB）和一大批（约 90,000 名）严格匹配的多年来严重肥胖的非手术患者 2005-2019 年，随访至 2021 年。超过 5,000 名手术患者和 15,000 名非手术患者有指数 2012 年之前的日期将包含 10 年或更长时间的数据，这使其成为迄今为止规模最大的经济研究 随访时间最长的研究。我们建议实现三个目标： 目标 1：比较接受 SG 和 RYGB 的患者医疗保健总成本的 5 年和 10 年变化 与匹配的患有严重肥胖的非手术患者进行比较。 目标 2：检查手术对成本影响的异质性，以了解是否存在临床影响 具有更有利的术后费用轨迹的严重肥胖患者亚组。 • 目标2a：我们将检查所有手术患者和匹配的非手术患者之间的异质性。 • 目标2b：我们将检查T2DM 手术患者及其匹配患者之间的异质性。 目标 3：估计目标 2 中确定的每个子组达到收支平衡的时间，以确定投资回报率 考虑到手术的初始费用后，需要 5 至 10 年的时间框架。