Cost-effectiveness and Budget Impact of Obesity Surgery in Patients with Type 2 Diabetes in Three European Countries(II)
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This study aimed to establish a payer-perspective cost-effectiveness and budget impact model of adjustable gastric banding (AGB) and gastric bypass (GBP) vs. conventional treatment (CT) in patients with a body mass index (BMI) ≥ 35 kg.m−2 and type 2 diabetes mellitus (T2DM) in Austria, Italy, and Spain.
A health economics model described in a previous publication was applied to resource utilization and cost data in AGB, GBP, and CT from Austria, Italy, and Spain in 2009.
The base case time scope is 5 years; the annual discount rate for utilities and costs is 3.5%. In Austria and Italy, both AGB and GBP are cost-saving and are thus dominant in terms of incremental cost-effectiveness ratio compared to CT. In Spain, AGB and GBP yield a moderate cost increase but are cost-effective, assuming a willingness-to-pay threshold of 30,000 euro per quality adjusted life-year. Under worst-case analysis, AGB and GBP remain cost-saving or around breakeven in Austria and Italy and remain cost-effective in Spain.
In patients with T2DM and BMI ≥ 35 kg.m−2 at 5-year follow-up vs. CT, AGB and GBP are not only clinically effective and safe but represent satisfactory value for money from a payer perspective in Austria, Italy, and Spain.
KeywordsObesity surgery Gastric bypass Adjustable gastric banding Cost-effectiveness Budget impact EQ-5D utility Diabetes
Adjustable gastric banding
EuroQol three-level five-dimensional
Health technology assessment
Leistungsorientierte Krankenanstaltenfinanzierung: the point-based Austrian service-based hospital funding
Incremental cost-effectiveness ratio
Quality adjusted life-years
Type 2 diabetes mellitus
Willingness to pay: the maximum ICER accepted by health care payers
Financial support by Ethicon Endo-Surgery for Excel model software development and for resource utilization collection by clinicians is acknowledge.
Conflict of Interest Statements
Dr. Marco Anselmino: Ethicon Endo-Surgery Consultant for Bariatric Surgery
Dr Tanja Bammer: none
Dr José Maria Fernández Cebrián: none
Dr Frederic Daoud: Consultant in clinical epidemiology to Ethicon Endo-Surgery
Dr Giuliano Romagnoli: none
Pr Antonio Torres: none
- 1.National Institute for Clinical Excellence. Guidance on the use of surgery to aid weight reduction for people with morbid obesity. Technology appraisal—guidance no. 46. 2002.Google Scholar
- 6.Ministero del Lavoro della Salute e delle Politiche Soziali. Centro Nazionale per la Prevenzione e il Controllo delle Malattie. Evidence-based prevention. EBP e obesita. Direct link to NICE. 2009. website. https://doi.org/www.ccm-network.it/ebp_e_obesita/enti_istituti.
- 7.Corbella A. Linee Guida Nice (National Institute For Clinical Excellence) NHS (National Health Service) Servizio Sanitario Nazionale Inglese Titolo: Cadute: La Valutazione E La Prevenzione Delle Cadute Nelle Persone Anziane. Lineeguida Cliniche N. 21. Unità di gestione del rischio dell'ASL 3 Genovese. https://doi.org/www.gestionerischio.asl3.liguria.it/pdf/traduzione%20linee%20guida%20nice2.pdf. 2004.
- 8.Razdik D. U.O di Pediatria Ospedale di Castelfranco Veneto (TV). Analisi Critica Delle Linee Guida Sull’uso Dei Distanziatori Nell’asma Bronchiale Infantile Società Italiana di Immunologia e Allergologia Pediatrica (SIAIP); https://doi.org/www.siaip.it/atom/atom/allegato/207.pdf. 2007.
- 9.Clegg AJ, Colquitt J, Sidhu MK et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. The National Coordinating Center for Health Technology Assessment (SPAIN). 2002.Google Scholar
- 10.National Institute for Clinical Excellence. Guide to the methods of technology appraisal. 2004.Google Scholar
- 11.HM Treasury. The green book, annex 6. http://greenbook.treasury.gov.uk/annex06.htm. 2003.
- 12.National Institute for Clinical Excellence. Guide to the methods of technology appraisal. Reference N1618. www.nice.org.uk. 2008.
- 14.STATISTIK AUSTRIA—Gesundheitsausgaben. Gesundheitsausgaben in Österreich laut System of Health Accounts (OECD) 1 1990–2006, in Mio. EUR. Öffentliche Gesundheitsausgaben, insgesamt. https://doi.org/www.statistik.at/web_de/statistiken/gesundheit/gesundheitsausgaben/019701.html.
- 15.Steiermärkische Gebietskrankenkasse, DI Fritz Bruner. Presentation at health-connex 06, October 9–11 2006.Google Scholar
- 17.García-Altés A. Agència de Salut Pública de Barcelona. Fundación Instituto de Investigación en Servicios de Salud. Catalan Agency for Health Technology Assessment and Research (CAHTA). Newsletter, Issue 38, January 2006.Google Scholar