title: Cost-Effectiveness of Bariatric Surgery for Type 2 Diabetes Mellitus: A Randomized Controlled Trial in China.
abstract: To compare the remission of type 2 diabetes mellitus (T2DM) through treatment with laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB), and to analyze the cost-effectiveness of medical treatment, LSG, and LRYGB in T2DM patients (BMI ≥ 28).A 2-group randomized controlled trial was conducted at Diabetes Surgery Centre, Beijing Shijitan Hospital in Beijing, China. Subjects were 80 patients ages 16 to 65 years with a body mass index of 28 kg/m or more and duration of T2DM no more than 15 years. Subjects were randomly assigned (1:1) to undergo either LSG (n = 40) or LRYGB (n = 40) between February 3, 2011 and October 31, 2013. Of those patients, 72 (90%) were available at follow-up at 2 years. These patients included 34 (85%) who underwent LSG and 38 (95%) who underwent LRYGB. This study presents the follow-up data at 2 years, which compared LSG and LRYGB in T2DM patients. Partial remission and complete remission were determined, and weight loss, BMI, changes in abdominal circumference, cholesterol, and triglycerides were measured. The cost-effectiveness of each type of bariatric surgery was analyzed with a Markov simulation model that yielded quality-adjusted life-years (QALYs) and costs.From our analysis results, LSG and LRYGB are both have taken a great effect on the reduction of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and bodyweight in patients with T2DM. The cost-effectiveness ratios of medical treatment, LSG, and LRYGB respectively are 1589.02, 1028.97, and 1197.44 dollars per QALY.Our analysis indicates that LSG appear to provide a cost-effective method of T2DM treatment for the patients.
authors.affiliation: From the Department of Social Medicine and Medical Service Management (QT, LX, WT), School of Public Health, Shandong University, Jinan, China; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery (QT, ZS, PS, WT), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; and Diabetes Surgery Centre (ZS, NZ, GX), Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Tang
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Sun
authors.forename: Nengwei
authors.initials: N
authors.lastname: Zhang
authors.forename: Guangzhong
authors.initials: G
authors.lastname: Xu
authors.forename: Peipei
authors.initials: P
authors.lastname: Song
authors.forename: Lingzhong
authors.initials: L
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002681:China; D002784:Cholesterol / Q000097:blood; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000191:economics* / Q000379:methods; D015390:Gastric Bypass / Q000191:economics*; D006442:Glycated Hemoglobin / Q000378:metabolism; D017048:Health Care Costs; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D010535:Laparoscopy / Q000191:economics; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference; D015431:Weight Loss; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D014280:Triglycerides; C517652:hemoglobin A1c protein, human