Siva T Gounder1, Delendra Rasith Wijayanayaka2, Rinki Murphy3, Delwyn Armstrong4, Richard G Cutfield5, David Dw Kim6, Michael Graham Clarke7, Nicholas J Evennett8, Martyn Lee Humphreys9, Steven John Robinson10, Michael Wc Booth11. 1. Consultant Bariatric and General Surgeon, St John of God Hospital Midland, Perth, Western Australia. 2. Registrar, Dunedin Public Hospital, Dunedin. 3. Diabetologist, University of Auckland, Auckland. 4. Health Intelligence Manager, Waitemata DHB, Auckland. 5. Endocrinologist, Department of Medicine, North Shore Hospital, Auckland. 6. Endocrinologist, Department of Endocrinology, Waitemata DHB, Auckland. 7. Consultant Upper GI and Bariatric Surgeon, Cornwall Metabolic and Bariatric Surgery Unit, Royal Cornwall Hospital, Truro, Cornwall, UK. 8. UGI and Bariatric Surgeon, Department of Surgery, Auckland City Hospital, Auckland. 9. Consultant Upper GI and Bariatric Surgeon, Peninsula Oesophagogastric Unit, Derriford Hospital, Plymouth, UK. 10. Consultant Upper GI and Bariatric Surgeon, Worcestershire Acute Hospitals NHS Trust, Worcester, UK. 11. Consultant Upper GI and Bariatric Surgeon, North Shore Hospital, Auckland.
Abstract
AIM: To provide a longitudinal analysis of the direct healthcare costs of providing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery service in the context of a randomised control trial (RCT) of obese patients with type 2 diabetes in Waitemata District Health Board, Auckland, New Zealand. METHODS: The Waitemata District Health Board costing system was used to calculate costs in New Zealand Dollars (NZD) associated with all pre- and post-operative hospital clinic visits, peri-operative care, hospitalisations and medication costs up to one year after bariatric surgery. Healthcare costs of medications, laboratory investigations and hospital clinic visits for one year prior to enrolment into the RCT were also calculated. RESULTS:One hundred and fourteen patients were randomised to undergo laparoscopic sleeve gastrectomy (LSG, n=58) or laparoscopic Roux en Y gastric bypass (LRYGB, n=56). Total costs one year pre-enrolment was $203,926 for all patients (mean $1,789 per patient). Total cost of surgery was $1,208,005 (mean $9,131 per LSG patient and mean $12,456 per LRYGB patient). Total cost one year post-operatively was $542,656 (mean $4,760 per patient). The total medication cost reduced from $118,993.72(mean $1,044 per patient) to $31,304.93 (mean $274.60 per patient), p<0.005. The largest cost reduction was seen with annual diabetic medications reducing from $110,115.78(mean $965.93 per patient) to $7,237.85 (mean $63.48 per patient), p<0.005. CONCLUSIONS: Among patients with type 2 diabetes and morbid obesity undergoing LSG andLRYGB, health service costs were greater in the year after surgery than in the year before, although prescription costs were lower post-operatively. There was no significant difference in reduction in prescription cost by surgical procedure at 12 months. However, the LRYGB surgery was more expensive than LSG, primarily because of the longer operative time required.
RCT Entities:
AIM: To provide a longitudinal analysis of the direct healthcare costs of providing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery service in the context of a randomised control trial (RCT) of obesepatients with type 2 diabetes in Waitemata District Health Board, Auckland, New Zealand. METHODS: The Waitemata District Health Board costing system was used to calculate costs in New Zealand Dollars (NZD) associated with all pre- and post-operative hospital clinic visits, peri-operative care, hospitalisations and medication costs up to one year after bariatric surgery. Healthcare costs of medications, laboratory investigations and hospital clinic visits for one year prior to enrolment into the RCT were also calculated. RESULTS: One hundred and fourteen patients were randomised to undergo laparoscopic sleeve gastrectomy (LSG, n=58) or laparoscopic Roux en Y gastric bypass (LRYGB, n=56). Total costs one year pre-enrolment was $203,926 for all patients (mean $1,789 per patient). Total cost of surgery was $1,208,005 (mean $9,131 per LSG patient and mean $12,456 per LRYGB patient). Total cost one year post-operatively was $542,656 (mean $4,760 per patient). The total medication cost reduced from $118,993.72(mean $1,044 per patient) to $31,304.93 (mean $274.60 per patient), p<0.005. The largest cost reduction was seen with annual diabetic medications reducing from $110,115.78(mean $965.93 per patient) to $7,237.85 (mean $63.48 per patient), p<0.005. CONCLUSIONS: Among patients with type 2 diabetes and morbid obesity undergoing LSG and LRYGB, health service costs were greater in the year after surgery than in the year before, although prescription costs were lower post-operatively. There was no significant difference in reduction in prescription cost by surgical procedure at 12 months. However, the LRYGB surgery was more expensive than LSG, primarily because of the longer operative time required.
Authors: Rinki Murphy; Michael G Clarke; Nicholas J Evennett; S John Robinson; M Lee Humphreys; Hisham Hammodat; Bronwen Jones; David D Kim; Richard Cutfield; Malcolm H Johnson; Lindsay D Plank; Michael W C Booth Journal: Obes Surg Date: 2018-02 Impact factor: 4.129
Authors: Brett Doble; Richard Welbourn; Nicholas Carter; James Byrne; Chris A Rogers; Jane M Blazeby; Sarah Wordsworth Journal: Obes Surg Date: 2019-02 Impact factor: 4.129
Authors: Rinki Murphy; Lindsay D Plank; Michael G Clarke; Nicholas J Evennett; James Tan; David D W Kim; Richard Cutfield; Michael W C Booth Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152
Authors: Qing Xia; Julie A Campbell; Hasnat Ahmad; Barbara de Graaff; Lei Si; Petr Otahal; Kevin Ratcliffe; Julie Turtle; John Marrone; Mohammed Huque; Barry Hagan; Matthew Green; Andrew J Palmer Journal: Eur J Health Econ Date: 2021-11-12
Authors: Jacqueline A Murtha; Dillon C Svoboda; Natalie Liu; Morgan K Johnson; Manasa Venkatesh; Jacob A Greenberg; Anne O Lidor; Luke M Funk Journal: J Laparoendosc Adv Surg Tech A Date: 2021-07-12 Impact factor: 1.766
Authors: Tomasz Stefura; Artur Kacprzyk; Jakub Droś; Katarzyna Chłopaś; Michał Wysocki; Anna Rzepa; Magdalena Pisarska; Piotr Małczak; Michał Pędziwiatr; Michał Nowakowski; Andrzej Budzyński; Piotr Major Journal: Wideochir Inne Tech Maloinwazyjne Date: 2019-10-29 Impact factor: 1.195