Cost-effectiveness of Roux-en-Y gastric bypass in type 2 diabetes patients.
OBJECTIVE
To assess the cost-effectiveness of Roux-en-Y gastric bypass for treating type 2 diabetes mellitus (T2DM) in the United States compared with standard medical management, using clinical data from a prospective observational study conducted at an academic medical center.


METHODS
Our study used a predictive health economic model (the CORE Diabetes Model) to project the long-term costs and clinical effectiveness of Roux-en-Y gastric bypass as a treatment for T2DM using the prospective observational study as the basis for our clinical effectiveness assumptions.


METHODS
The CORE Diabetes Model used Monte Carlo simulation with tracker variables to estimate the lifetime costs and clinical outcomes of Roux-en-Y gastric bypass compared with standard medical management of obese T2DM patients. Sensitivity analyses were performed on key clinical assumptions, discount rates, and shorter time horizons.


RESULTS
The base-case scenario yielded an incremental cost-effectiveness ratio (ICER) of $21,973 per quality-adjusted life-year (QALY) gained. In sensitivity analyses, shortening the time horizon to 5 and 10 years and excluding the negative impact of increased body mass index on the patient's quality of life had the greatest adverse impact on the ICERs (ie, higher cost per QALY).


CONCLUSIONS
Under base-case assumptions, Roux-en-Y gastric bypass is cost-effective in the treatment of T2DM in the United States with an ICER below $50,000 per QALY gained. Sensitivity analyses indicated that bariatric surgery is not cost-effective over shorter time horizons, or if the negative quality-of-life impact of increased body mass index is ignored.
Ikramuddin
Sayeed
S
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Klingman
David
D
Swan
Therese
T
Minshall
Michael E
ME
D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control; D005260:Female; D015390:Gastric Bypass / Q000191:economics*; D006442:Glycated Hemoglobin / Q000191:economics; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D009765:Obesity / Q000191:economics / Q000601:surgery; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014481:United States
D006442:Glycated Hemoglobin