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.
Similar content being viewed by others
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
References
National Institute for Clinical Excellence. Guidance on the use of surgery to aid weight reduction for people with morbid obesity. Technology appraisal—guidance no. 46. 2002.
Buchwald H, Avido Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
Ackroyd R, Mouiel J, Chevallier JM, et al. Cost-effectiveness and budget impact of obesity surgery in patients with type-2 diabetes in three European countries. Obes Surg. 2006;16(11):1488–503.
Jönsson B. Revealing the cost of type-2 diabetes in Europe. Diabetologia. 2002;45:S5–12.
Moreno O, Meoro A, Martinez A, et al. Comparison of two low-calorie diets: a prospective study of effectiveness and safety. J Endocrinol Invest. 2006;29(7):633–40.
Ministero del Lavoro della Salute e delle Politiche Soziali. Centro Nazionale per la Prevenzione e il Controllo delle Malattie. Evidence-based prevention. EBP e obesita. Direct link to NICE. 2009. website. https://doi.org/www.ccm-network.it/ebp_e_obesita/enti_istituti.
Corbella A. Linee Guida Nice (National Institute For Clinical Excellence) NHS (National Health Service) Servizio Sanitario Nazionale Inglese Titolo: Cadute: La Valutazione E La Prevenzione Delle Cadute Nelle Persone Anziane. Lineeguida Cliniche N. 21. Unità di gestione del rischio dell'ASL 3 Genovese. https://doi.org/www.gestionerischio.asl3.liguria.it/pdf/traduzione%20linee%20guida%20nice2.pdf. 2004.
Razdik D. U.O di Pediatria Ospedale di Castelfranco Veneto (TV). Analisi Critica Delle Linee Guida Sull’uso Dei Distanziatori Nell’asma Bronchiale Infantile Società Italiana di Immunologia e Allergologia Pediatrica (SIAIP); https://doi.org/www.siaip.it/atom/atom/allegato/207.pdf. 2007.
Clegg AJ, Colquitt J, Sidhu MK et al. The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation. The National Coordinating Center for Health Technology Assessment (SPAIN). 2002.
National Institute for Clinical Excellence. Guide to the methods of technology appraisal. 2004.
HM Treasury. The green book, annex 6. http://greenbook.treasury.gov.uk/annex06.htm. 2003.
National Institute for Clinical Excellence. Guide to the methods of technology appraisal. Reference N1618. www.nice.org.uk. 2008.
Iannazzo S, Zaniolo O, Pradelli L. Economic evaluation of treatment with Orlistat in Italian obese patients. Curr Med Res Opin. 2008;24(1):63–74.
STATISTIK AUSTRIA—Gesundheitsausgaben. Gesundheitsausgaben in Österreich laut System of Health Accounts (OECD) 1 1990–2006, in Mio. EUR. Öffentliche Gesundheitsausgaben, insgesamt. https://doi.org/www.statistik.at/web_de/statistiken/gesundheit/gesundheitsausgaben/019701.html.
Steiermärkische Gebietskrankenkasse, DI Fritz Bruner. Presentation at health-connex 06, October 9–11 2006.
Dorner T, Rathmanner T, Lechleitner M, et al. Public health aspects of diabetes mellitus—epidemiology, prevention strategies, policy implications: the First Austrian Diabetes Report. Wien Klin Wochenschr. 2006;118(17–18):513–9.
García-Altés A. Agència de Salut Pública de Barcelona. Fundación Instituto de Investigación en Servicios de Salud. Catalan Agency for Health Technology Assessment and Research (CAHTA). Newsletter, Issue 38, January 2006.
Oliva J, Lobo F, Molina B, et al. Direct health care costs of diabetic patients in Spain. Diabetes Care. 2004;27(11):2616–21.
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
Corresponding author
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-009-9946-z