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Cost-effectiveness and Budget Impact of Obesity Surgery in Patients with Type 2 Diabetes in Three European Countries(II)

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

ABG:

Adjustable gastric banding

BI:

Budget impact

CT:

Conventional treatment

DRG:

Diagnostic-related group

EQ-5D:

EuroQol three-level five-dimensional

GBP:

Gastric bypass

HTA:

Health technology assessment

LKF:

Leistungsorientierte Krankenanstaltenfinanzierung: the point-based Austrian service-based hospital funding

ICER:

Incremental cost-effectiveness ratio

QALYs:

Quality adjusted life-years

T2DM:

Type 2 diabetes mellitus

WTP:

Willingness to pay: the maximum ICER accepted by health care payers

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Acknowledgements

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

Author information

Authors and Affiliations

  1. Bariatric Surgery Unit, Azienda Ospedaliera Pisana, Via Roma 67, 56127, Pisa, Italy

    Marco Anselmino

  2. Surgery Unit BKH Kufstein, Endach 27, 6330, Kufstein, Austria

    Tanja Bammer

  3. Fundación Hospital Alcorcón, Calle Budapest 1, 28922, Alcorcón, Spain

    José Maria Fernández Cebrián

  4. Medextens Clinical Epidemiology Dept., 75 rue de Lourmel, 75015, Paris, France

    Frederic Daoud

  5. U.O. di Chirurgia Ospedale Civile di Legnano, P.O, di Magenta, Via Al Donatore di Sangue 50, 20013, Magenta, Italy

    Giuliano Romagnoli

  6. Complutense University of Madrid Hospital Clinico San Carlos, Avda Soller 109, 28290, Madrid, Spain

    Antonio Torres

Authors
  1. Marco Anselmino
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  2. Tanja Bammer
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  3. José Maria Fernández Cebrián
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  4. Frederic Daoud
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  5. Giuliano Romagnoli
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  6. Antonio Torres
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Corresponding author

Correspondence to Frederic Daoud.

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Anselmino, M., Bammer, T., Fernández Cebrián, J.M. et al. Cost-effectiveness and Budget Impact of Obesity Surgery in Patients with Type 2 Diabetes in Three European Countries(II). OBES SURG 19, 1542–1549 (2009). https://doi.org/10.1007/s11695-009-9946-z

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