Yinfang Tu1, Liang Wang2, Li Wei3, Youhao Xu4, Xiaodong Han5, Junfeng Han1, Haoyong Yu1, Chao Zheng2, Yuqian Bao6, Weiping Jia7. 1. Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. 2. Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China. 3. Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201306, China. 4. Department of Computer Center, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. 5. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. 6. Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. byq522@163.com. 7. Department of Endocrinology and Metabolism, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China. wpjia@sjtu.edu.cn.
Abstract
OBJECTIVES: To find whether Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery was cost effective compared to conventional medical management (CMM) in Chinese patients with type 2 Diabetes(T2D) and obesity with a body mass index (BMI) ≥27.5 kg/m2 in four years. METHODS: A total of 106 obese T2D individuals who underwent RYGB and 106 T2D patients treated with CMM were enrolled from three academic medical centers. Total health related costs, Glycated Hemoglobin A1c (A1C) and BMI was recorded. Cost-Utility Analysis (CUA) was used. Utility values according to results of A1c were obtained from published studies. RESULTS: Improvements were observed in A1C (8.6% at baseline to 6.2% in the first year, p < 0.001) and BMI (30.7 kg/m2 at baseline to 24.3 kg/m2 in the first year, p < 0.001), and the effect lasted for 4 years after RYGB. In the CMM group, A1C fluctuated in four years. The health utility for RYGB group scores 3.756, whereas CMM group scores 3.594 in four years. The total healthcare costs decreased sharply from the second year after RYGB ($8,483 [¥52,596] in the first year to $672[¥4,164] in the second year, p < 0.001) and maintained for 3 years. In the CMM group, the total healthcare costs changed without significance. RYGB costs US$19,359 (¥125,836) per quality-adjusted life years (QALY) gained (incremental cost-utility ratio [ICUR]) compared to CMM, which was lower than a willingness-to-pay (WTP) of $20,277/QALY. CONCLUSIONS: Compared to CMM, RYGB is cost-effective for Chinese patients with type 2 diabetes and obesity 4 years after operation.
OBJECTIVES: To find whether Laparoscopic Roux-en-Y gastric bypass (RYGB) surgery was cost effective compared to conventional medical management (CMM) in Chinese patients with type 2 Diabetes(T2D) and obesity with a body mass index (BMI) ≥27.5 kg/m2 in four years. METHODS: A total of 106 obese T2D individuals who underwent RYGB and 106 T2D patients treated with CMM were enrolled from three academic medical centers. Total health related costs, Glycated Hemoglobin A1c (A1C) and BMI was recorded. Cost-Utility Analysis (CUA) was used. Utility values according to results of A1c were obtained from published studies. RESULTS: Improvements were observed in A1C (8.6% at baseline to 6.2% in the first year, p < 0.001) and BMI (30.7 kg/m2 at baseline to 24.3 kg/m2 in the first year, p < 0.001), and the effect lasted for 4 years after RYGB. In the CMM group, A1C fluctuated in four years. The health utility for RYGB group scores 3.756, whereas CMM group scores 3.594 in four years. The total healthcare costs decreased sharply from the second year after RYGB ($8,483 [¥52,596] in the first year to $672[¥4,164] in the second year, p < 0.001) and maintained for 3 years. In the CMM group, the total healthcare costs changed without significance. RYGB costs US$19,359 (¥125,836) per quality-adjusted life years (QALY) gained (incremental cost-utility ratio [ICUR]) compared to CMM, which was lower than a willingness-to-pay (WTP) of $20,277/QALY. CONCLUSIONS: Compared to CMM, RYGB is cost-effective for Chinese patients with type 2 diabetes and obesity 4 years after operation.
Entities:
Keywords:
Body mass index (BMI); Cost-utility analysis (CUA); Glycated hemoglobin A1c (A1C); Obesity; Quality-adjusted life years (QALY); roux-en-Y gastric bypass (RYGB); Total healthcare costs; Type 2 diabetes(T2D)
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