RESUMO
BACKGROUND: We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain. METHODS: We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (2017). RESULTS: Over the 10-year horizon, BS led to a cost increment of 9,386 and 1.6 additional QALY (5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and 300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss. CONCLUSIONS: Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.
Assuntos
Cirurgia Bariátrica/métodos , Tratamento Conservador/métodos , Obesidade Mórbida/terapia , Adulto , Idoso , Cirurgia Bariátrica/economia , Tratamento Conservador/economia , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Anos de Vida Ajustados por Qualidade de Vida , EspanhaRESUMO
INTRODUCTION: Laparoscopic surgery offers an alternative diagnostic technique in multiple diseases requiring biopsy of non-digestive intra-abdominal masses in which image-guided biopsy cannot be performed. Laparoscopic biopsy aims to reduce the surgical aggression and complications associated with laparotomy and favors the early treatment of malignancies. PATIENTS AND METHOD: We performed a retrospective descriptive study of our results in a series of patients in our hospital with intra-abdominal masses of unknown etiology who underwent laparoscopic surgery between January 2001 and April 2006. None of the patients were candidates for image-guided percutaneous biopsy. RESULTS: We carried out 23 biopsies: 8 retroperitoneal (34.7%), 5 mesenteric (21.7%), 5 hepatic, 4 pelvic, and 1 in the iliac chain, as well as 5 complementary biopsies. In all patients, sufficient material for histologic diagnosis was obtained. The mean operating time was 71 minutes. Length of hospital stay was less than 24 hours in 61% of the patients. The median length of hospital stay was 1.5 days. CONCLUSIONS: The laparoscopic approach allows complete visualization and examination of the entire peritoneal cavity. Laparoscopic biopsy is a safe and effective procedure with excellent patient recovery and allows early definitive treatment.