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: 10375567
• 负责人: David Eric Arterburn
• 金额: $ 67.37万
• 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/10375567
• 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 减肥手术是严重肥胖的最有效治疗方法，但只有1-2％的符合条件的患者 每年接受手术。减肥手术的摄取率低的持续性持续 严重肥胖的成本和减肥手术的优势在诱导临床意义和持续 体重减轻，长期生存以及与肥胖相关的健康状况的重大改善[即2型 与通常的医疗服务相比，糖尿病（T2DM）]。使用减肥手术的障碍包括患者和 物理学的知识并参加这些程序；缺乏非手术治疗的资源 严重的肥胖；以及由于保险不足而产生的较高的患者费用。覆盖不足和 在私人保险dospite Medicare中，有明显的外科手术前要求提供全面覆盖 对于> 20年的减肥手术，并且证据表明减肥手术的成本效益小于50,000美元/QALY。 减肥手术的覆盖范围持续的差距似乎是由于对长期成本的担忧而驱动的 并发症和手术的潜在预算巨大影响，因为约有15％的美国成年人有资格参加减肥 手术和每次手术费用很高（$ 20-30,000/程序）。结果，付款人可能需要证据 在提供更广泛的覆盖范围之前，这种减肥手术是省钱的。 经济证据中有四个主要差距是扩大私人保险的障碍 减肥手术的覆盖范围。我们建议通过比较5年和10年来解决这些证据差距 约有30,000名患者的支出，这些患者以前接受了两种最常见的减肥手术（SG和SG和 rygb）和大量匹配的严重肥胖症患者（约90,000）（约90,000个） 2005- 2019年，随访至2021年。超过5,000名手术患者和15,000名非手术指数患者 2012年之前的日期将在10年或以上有数据，这使得这是迄今为止最大的经济研究 随访最长的研究。我们建议解决三个目标： 目标1：比较接受SG和RYGB的患者的5年和10年的医疗保健总成本变化 相对于匹配的非手术性肥胖症患者。 目标2：检查手术对成本的影响的异质性，以了解是否存在临床 严重肥胖患者的亚组，这些患者具有更有利的手术后成本轨迹。 •AIM 2A：我们将检查所有手术患者的异质性并匹配非手术患者。 •AIM 2B：我们将检查T2DM外科患者的异质性及其匹配。 AIM 3：估计AIM 2中确定的每个子组的分支的时间以确定投资回报率 在考虑手术初始费用后，在5到10年的时间范围内。