Cost-efficacy of surgically induced weight loss for the management of type 2 diabetes: a randomized controlled trial.
OBJECTIVE
To determine the within-trial cost-efficacy of surgical therapy relative to conventional therapy for achieving remission of recently diagnosed type 2 diabetes in class I and II obese patients.


METHODS
Efficacy results were derived from a 2-year randomized controlled trial. A health sector perspective was adopted, and within-trial intervention costs included gastric banding surgery, mitigation of complications, outpatient medical consultations, medical investigations, pathology, weight loss therapies, and medication. Resource use was measured based on data drawn from a trial database and patient medical records and valued based on private hospital costs and government schedules in 2006 Australian dollars (AUD). An incremental cost-effectiveness analysis was undertaken.


RESULTS
Mean 2-year intervention costs per patient were 13,400 AUD for surgical therapy and 3,400 AUD for conventional therapy, with laparoscopic adjustable gastric band (LAGB) surgery accounting for 85% of the difference. Outpatient medical consultation costs were three times higher for surgical patients, whereas medication costs were 1.5 times higher for conventional patients. The cost differences were primarily in the first 6 months of the trial. Relative to conventional therapy, the incremental cost-effectiveness ratio for surgical therapy was 16,600 AUD per case of diabetes remitted (currency exchange: 1 AUD = 0.74 USD).


CONCLUSIONS
Surgical therapy appears to be a cost-effective option for managing type 2 diabetes in class I and II obese patients.
Keating
Catherine L
CL
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York, USA. catherine.keating@deakin.edu.au
Dixon
John B
JB
Moodie
Marjory L
ML
Peeters
Anna
A
Playfair
Julie
J
O'Brien
Paul E
PE
D001315:Australia; D050110:Bariatric Surgery / Q000191:economics*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004358:Drug Therapy / Q000191:economics*; D006801:Humans; D009765:Obesity / Q000150:complications / Q000191:economics / Q000601:surgery*; D013997:Time Factors; D015431:Weight Loss