Cost-effectiveness and budget impact of obesity surgery in patients with type 2 diabetes in three European countries(II).
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) > or = 35 kg x 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.


CONCLUSIONS
In patients with T2DM and BMI > or = 35 kg x 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.
Anselmino
Marco
M
Bariatric Surgery Unit, Azienda Ospedaliera Pisana, Via Roma 67, 56127 Pisa, Italy.
Bammer
Tanja
T
Fernández Cebrián
José Maria
JM
Daoud
Frederic
F
Romagnoli
Giuliano
G
Torres
Antonio
A
D001317:Austria; D015992:Body Mass Index; D002017:Budgets; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics* / Q000601:surgery; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000191:economics*; D015391:Gastroplasty / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D018803:Models, Economic; D009767:Obesity, Morbid / Q000150:complications / Q000191:economics* / Q000601:surgery; D013030:Spain; D016896:Treatment Outcome; D015431:Weight Loss