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Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort

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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.

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Acknowledgments

Thank Professor Weijian Xuan of Sun Yat-sen University for his help in the analysis of Pharmacoeconomics. Thanks to many people who participated in this research.

Funding

This work is supported by the National Key Research and Development Program of China (2016YFA0502003), the National Natural Science Foundation of China (81570713), the National Key Research and Development Program (2016YFC0903303), the Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support (20152527), the Outstanding Academic Leaders of Shanghai Health System (2017BR008), Municipal Natural Science Foundation of Shanghai (17ZR1421200) and the Yangtze River Scholar.

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Author notes

  1. Yinfang Tu and Liang Wang contributed equally to this work.

Authors and Affiliations

  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

    Yinfang Tu, Junfeng Han, Haoyong Yu, Yuqian Bao & Weiping Jia

  2. Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang, China

    Liang Wang & Chao Zheng

  3. Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, 201306, China

    Li Wei

  4. Department of Computer Center, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Youhao Xu

  5. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, 200233, China

    Xiaodong Han

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  1. Yinfang Tu
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Correspondence to Yuqian Bao or Weiping Jia.

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Statement of Informed Consent

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

Statement of Human Rights

This study was approved by the Ethics Committee of the Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and complied with the Declaration of Helsinki.

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Tu, Y., Wang, L., Wei, L. et al. Cost-Utility of Laparoscopic Roux-en-Y Gastric Bypass in Chinese Patients with Type 2 Diabetes and Obesity with a BMI ≥ 27.5 kg/m2: a Multi-Center Study with a 4-Year Follow-Up of Surgical Cohort. OBES SURG 29, 3978–3986 (2019). https://doi.org/10.1007/s11695-019-04069-y

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