Cost-effectiveness of metabolic surgery for the treatment of type 2 diabetes and obesity: a systematic review of economic evaluations

Abstract

Aim To systematically identify and appraise the international literature on the cost-effectiveness of metabolic surgery for the treatment of comorbid type 2 diabetes (T2D) and obesity. Methods A systematic search was conducted in electronic databases and grey literature sources up to 20 January 2021. Economic evaluations in a T2D population or a subpopulation with T2D were eligible for inclusion. Screening, data extraction, critical appraisal of methodological quality (Consensus Health Economic Criteria list) and assessment of transferability (International Society for Pharmacoeconomics and Outcomes Research questionnaire) were undertaken in duplicate. The incremental cost-effectiveness ratio (ICER) was the main outcome. Costs were reported in 2020 Irish Euro. Cost-effectiveness was interpreted using willingness-to-pay (WTP) thresholds of €20,000 and €45,000/quality-adjusted life year (QALY). Due to heterogeneity arising from various sources, a narrative synthesis was undertaken. Results Thirty studies across seventeen jurisdictions met the inclusion criteria; 16 specifically in a T2D population and 14 in a subpopulation with T2D. Overall, metabolic surgery was found to be cost-effective or cost-saving. Where undertaken, the results were robust to sensitivity and scenario analyses. Of the 30 studies included, 15 were considered high quality. Identified limitations included limited long-term follow-up data and uncertainty regarding the utility associated with T2D remission. Conclusion Published high-quality studies suggest metabolic surgery is a cost-effective or cost-saving intervention. As the prevalence of obesity and obesity-related diseases increases worldwide, significant investment and careful consideration of the resource requirements needed for metabolic surgery programmes will be necessary to ensure that service provision is adequate to meet demand.

Uk Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty Versus Lifestyle Modification Alone for Adults With Class Ii Obesity

“…To the best of our knowledge this is the first published costeffectiveness analysis of ESG. The finding that ESG is cost effective versus LM alone is broadly consistent with published UK-based economic evaluations of other bariatric procedures for severe obesity which have been consistently shown to be cost effective versus LM with interventional costs partly offset by longer-term cost savings in the management of obesity-related comorbidities [19,50,51]. We have also adapted our cost-effectiveness analysis to reflect the US healthcare setting with similar results (manuscript in development) [52], suggesting that our overall findings are broadly generalisable to other developed countries.…”

Bariatric‐metabolic surgery for NHS patients with type 2 diabetes in the United Kingdom National Bariatric Surgery Registry

“…The use of bariatric‐metabolic surgery with shorter T2DM disease duration would likely lead to reduced patient treatment burden and higher rates of T2DM remission. From the health system perspective, bariatric‐metabolic surgery for people with T2DM and severe obesity has been reported as cost‐effective and may even be cost‐saving over longer time horizons 21,28 …”

“…From the health system perspective, bariatricmetabolic surgery for people with T2DM and severe obesity has been reported as cost-effective and may even be cost-saving over longer time horizons. 21,28 Possible reasons why bariatric-metabolic surgery appears to be used only in the later stages of T2DM include obesity stigma in healthcare professionals that could disadvantage people with obesity accessing evidencebased care 29 ; lack of participants 30 and primary care clinicians 31,32 awareness of bariatric-metabolic surgery as a therapeutic option in T2DM, concerns about surgical complications 33 and variation in bariatric surgery commissioning influencing referral rates for surgery. A study of primary care clinicians reported little understanding of the role of bariatric-metabolic surgery despite the wideranging impact obesity has on physical and mental health issues.…”

A bariátriai műtétek egészségpolitikai szerepe a 2-es típusú cukorbetegségben szenvedő elhízott betegek ellátásában

“…A bariátriai műtétek költséghatékonyságát a diabetes konzervatív kezelésével összehasonlítva számos elemzés mutatta ki, és ezek többségében a műtétek domináns eljárásnak bizonyultak, tehát úgy tudtak többlet egészségnyereséget elérni, hogy közben költséget takarítottak meg [20,21].…”