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Economic evaluation of weight loss and transplantation strategies for kidney transplant candidates with obesity.
Puttarajappa, Chethan M; Smith, Kenneth J; Ahmed, Bestoun H; Bernardi, Karla; Lavenburg, Linda-Marie; Hoffman, William; Molinari, Michele.
Afiliação
  • Puttarajappa CM; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Electronic address: puttarajappacm@upmc.edu.
  • Smith KJ; Section of Decision Sciences, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Ahmed BH; Department of Surgery, Bariatric and Minimally Invasive and Bariatric Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Bernardi K; Department of Surgery, Bariatric and Minimally Invasive and Bariatric Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Lavenburg LM; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Hoffman W; Transplant Nephrology, University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA.
  • Molinari M; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Transplant ; 2024 Jul 30.
Article em En | MEDLINE | ID: mdl-39084464
ABSTRACT
Novel antiobesity medications, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), have expanded weight loss (WL) options for kidney transplantation (KT) candidates with obesity beyond lifestyle modifications and bariatric surgery. However, varying effectiveness, risk profiles, and costs make strategy choices challenging. To aid decision-making, we used a Markov model to examine the cost-effectiveness of different WL strategies over a 10-year horizon. A target WL of 15% of total body weight was used for the base case scenario, and we compared these strategies to a "liberal" KT strategy of transplanting candidates with obesity. Outcomes included costs (2023 US dollars), quality-adjusted life years, and incremental cost-effectiveness ratios. In analysis, a liberal KT strategy was favored over lifestyle modifications and GLP-1RAs. Among WL strategies, bariatric surgery was the most effective and cost the least, whereas lifestyle modification had the highest cumulative costs and was the least effective. Compared to liberal KT, bariatric surgery costs $45 859 per quality-adjusted life year gained. GLP-1RAs were favored over bariatric surgery only when drug costs were below $5000 per year (base cost $12 077). In conclusion, for KT candidates with obesity, a liberal KT strategy and bariatric surgery are preferred over lifestyle modifications alone and GLP-1RAs based on outcomes and cost-effectiveness.
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Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article