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Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System

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Abstract

Purpose

Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system.

Materials and Methods

A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate.

Results

Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs.

Conclusion

The study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.

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Acknowledgments

We thank the support of the Brazilian Institute of Health Technology (IATS)/National Council for Scientific and Technological Development (CNPq). We thank Prof. Luiz Guilherme Kraemer de Aguiar (PhD) and Prof. Walmir Ferreira Coutinho (PhD) for the permission to collect data with patients from their obesity treatment centers.

Funding

The National Council for Scientific and Technological Development (CNPq), process no. 457440/2013-9, funded this study.

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Authors and Affiliations

  1. Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil

    Roberto Pereira Assumpção, Luciana Ribeiro Bahia, Michelle Quarti Machado da Rosa & Denizar Araujo Vianna

  2. Biostatistics and Bioinformatics Department, National Institute of Cardiology, Rio de Janeiro, Brazil

    Marcelo Goulart Correia

  3. Department of Public Health, University of Brasilia,, Centro Metropolitano, conjunto A, lote 01, Brasília, Distrito Federal, 72.220-275, Brazil

    Everton Nunes da Silva

  4. Center of Morbid Obesity, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690/302, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil

    Paula Rosales Zubiaurre & Claudio Corá Mottin

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  1. Roberto Pereira Assumpção
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Contributions

LRB, DVA, and ENS conceived and designed the study; PRZ, MQR, and RPA performed the data collection and preliminary analysis; MGC developed the model and performed the statistical analysis; and LRB, RPA, and MQR wrote the draft manuscript. All authors revised and approved the manuscript.

Corresponding author

Correspondence to Roberto Pereira Assumpção.

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Conflicts of Interest

RPA received government grants to carry out the study. Authors RPA, LRB, DAV, MQR, RPA, ENS, PRZ, and CCM declare that they do not have any conflicts of interest. The study received funds for data monitoring and statistical analysis. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Research Ethics Committees of each institution approved this study and approved on the Brazil Platform for clinical trials with their related numbers: HSL/PUCRS (1.488.130), IEDE (855.012), and UERJ (731.209).

Consent Statement

Informed consent was obtained from all individual participants included in the study.

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Assumpção, R.P., Bahia, L.R., da Rosa, M.Q.M. et al. Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System. OBES SURG 29, 3202–3211 (2019). https://doi.org/10.1007/s11695-019-03957-7

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