Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses

Emma Rose McGlone, Iain Carey, Vladica Veličković, Prem Chana, Kamal Mahawar, Rachel L Batterham, James Hopkins, Peter Walton, Robin Kinsman, James Byrne, Shaw Somers, David Kerrigan, Vinod Menon, Cynthia Borg, Ahmed Ahmed, Bruno Sgromo, Chandra Cheruvu, Gul Bano, Catherine Leonard, Howard Thom, Carel W le Roux, Marcus Reddy, Richard Welbourn, Peter Small and Omar A Khan

PLOS Medicine, 2020, vol. 17, issue 12, 1-22

Abstract: Background: Although bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT). Methods and findings: Clinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000. Conclusions: In this study, we observed that in patients with obesity and T2DM-Ins, bariatric surgery was associated with high rates of postoperative cessation of insulin therapy, which is, in turn, a major driver of overall reductions in direct healthcare cost. Our findings suggest that a strategy utilising bariatric surgery for patients with obesity and T2DM-Ins is cost saving to the national healthcare provider (National Health Service (NHS)) over a 5-year time horizon. Emma Rose McGlone and colleagues report the clinical and cost- effectiveness of bariatric surgery for patients with Type 2 diabetes.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003228 (text/html)
https://journals.plos.org/plosmedicine/article/fil ... 03228&type=printable (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1003228

DOI: 10.1371/journal.pmed.1003228

Access Statistics for this article

More articles in PLOS Medicine from Public Library of Science
Bibliographic data for series maintained by plosmedicine ().