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Costs of bariatric surgery in a randomised control trial (RCT) comparing Roux en Y gastric bypass vs sleeve gastrectomy in morbidly obese diabetic patients.
Gounder, Siva T; Wijayanayaka, Delendra Rasith; Murphy, Rinki; Armstrong, Delwyn; Cutfield, Richard G; Kim, David Dw; Clarke, Michael Graham; Evennett, Nicholas J; Humphreys, Martyn Lee; Robinson, Steven John; Booth, Michael Wc.
Afiliação
  • Gounder ST; Consultant Bariatric and General Surgeon, St John of God Hospital Midland, Perth, Western Australia.
  • Wijayanayaka DR; Registrar, Dunedin Public Hospital, Dunedin.
  • Murphy R; Diabetologist, University of Auckland, Auckland.
  • Armstrong D; Health Intelligence Manager, Waitemata DHB, Auckland.
  • Cutfield RG; Endocrinologist, Department of Medicine, North Shore Hospital, Auckland.
  • Kim DD; Endocrinologist, Department of Endocrinology, Waitemata DHB, Auckland.
  • Clarke MG; Consultant Upper GI and Bariatric Surgeon, Cornwall Metabolic and Bariatric Surgery Unit, Royal Cornwall Hospital, Truro, Cornwall, UK.
  • Evennett NJ; UGI and Bariatric Surgeon, Department of Surgery, Auckland City Hospital, Auckland.
  • Humphreys ML; Consultant Upper GI and Bariatric Surgeon, Peninsula Oesophagogastric Unit, Derriford Hospital, Plymouth, UK.
  • Robinson SJ; Consultant Upper GI and Bariatric Surgeon, Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
  • Booth MW; Consultant Upper GI and Bariatric Surgeon, North Shore Hospital, Auckland.
N Z Med J ; 129(1443): 43-52, 2016 Oct 14.
Article em En | MEDLINE | ID: mdl-27736851
AIM: To provide a longitudinal analysis of the direct healthcare costs of providing laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery service in the context of a randomised control trial (RCT) of obese patients with type 2 diabetes in Waitemata District Health Board, Auckland, New Zealand. METHODS: The Waitemata District Health Board costing system was used to calculate costs in New Zealand Dollars (NZD) associated with all pre- and post-operative hospital clinic visits, peri-operative care, hospitalisations and medication costs up to one year after bariatric surgery. Healthcare costs of medications, laboratory investigations and hospital clinic visits for one year prior to enrolment into the RCT were also calculated. RESULTS: One hundred and fourteen patients were randomised to undergo laparoscopic sleeve gastrectomy (LSG, n=58) or laparoscopic Roux en Y gastric bypass (LRYGB, n=56). Total costs one year pre-enrolment was $203,926 for all patients (mean $1,789 per patient). Total cost of surgery was $1,208,005 (mean $9,131 per LSG patient and mean $12,456 per LRYGB patient). Total cost one year post-operatively was $542,656 (mean $4,760 per patient). The total medication cost reduced from $118,993.72(mean $1,044 per patient) to $31,304.93 (mean $274.60 per patient), p<0.005. The largest cost reduction was seen with annual diabetic medications reducing from $110,115.78(mean $965.93 per patient) to $7,237.85 (mean $63.48 per patient), p<0.005. CONCLUSIONS: Among patients with type 2 diabetes and morbid obesity undergoing LSG and LRYGB, health service costs were greater in the year after surgery than in the year before, although prescription costs were lower post-operatively. There was no significant difference in reduction in prescription cost by surgical procedure at 12 months. However, the LRYGB surgery was more expensive than LSG, primarily because of the longer operative time required.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Obesidade Mórbida / Derivação Gástrica / Custos de Cuidados de Saúde / Diabetes Mellitus Tipo 2 / Gastrectomia Tipo de estudo: Clinical_trials / Health_economic_evaluation Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Revista: N Z Med J Ano de publicação: 2016 Tipo de documento: Article
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Obesidade Mórbida / Derivação Gástrica / Custos de Cuidados de Saúde / Diabetes Mellitus Tipo 2 / Gastrectomia Tipo de estudo: Clinical_trials / Health_economic_evaluation Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Oceania Idioma: En Revista: N Z Med J Ano de publicação: 2016 Tipo de documento: Article