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Critical Review of Craig and Tseng Gastric Bypass

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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 arrangement.

Materials and Methods

A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical handling. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. Nosotros too 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 too 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-twelvemonth 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 toll-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 nigh the ICERs.

Conclusion

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

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Acknowledgments

We thank the support of the Brazilian Establish 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 Quango for Scientific and Technological Evolution (CNPq), process no. 457440/2013-nine, funded this study.

Author information

Affiliations

  1. Department of Internal Medicine, Land 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 Found of Cardiology, Rio de Janeiro, Brazil

    Marcelo Goulart Correia

  3. Section of Public Wellness, Academy 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 practise Sul, 90610-000, Brazil

    Paula Rosales Zubiaurre & Claudio Corá Mottin

Contributions

LRB, DVA, and ENS conceived and designed the study; PRZ, MQR, and RPA performed the data collection and preliminary analysis; MGC adult 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.

Ethics declarations

Conflicts of Interest

RPA received regime grants to comport out the study. Authors RPA, LRB, DAV, MQR, RPA, ENS, PRZ, and CCM declare that they do not have whatever conflicts of interest. The study received funds for information monitoring and statistical analysis. The funder had no part in study design, information drove and assay, 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 establishment 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, 50.R., da Rosa, G.Q.G. et al. Cost-Utility of Gastric Bypass Surgery Compared to Clinical Handling for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health Organisation. OBES SURG 29, 3202–3211 (2019). https://doi.org/10.1007/s11695-019-03957-7

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  • DOI : https://doi.org/10.1007/s11695-019-03957-seven

Keywords

  • Cost-utility
  • Obesity
  • Gastric featherbed surgery

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