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
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