S1446 Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty

Abstract

Introduction: Obesity continues to increase at an alarming rate. Endoscopic sleeve gastroplasty (ESG), a minimally invasive endoscopic weight loss procedure, has been shown to produce effective weight loss and improvement in obesity-related disease; however, it is unclear whether ESG is cost-effective. This study was created to assess the cost-effectiveness of endoscopic sleeve gastroplasty for weight loss in patients with obesity with or without type 2 diabetes (T2DM). Methods: A decision analytic model with time horizon of 5 years and lifetime, respectively, from a health system’s perspective was constructed to compare ESG to no weight loss intervention (no ESG) in obese patients aged 35-45 years with a body mass index (BMI) ≥30 kg/m2 with or without T2DM. Parameters including probabilities and utility weights were obtained based on published meta-analyses and retrospective studies (Table). Costs were taken from institutional data and were evaluated in 2022 U.S. dollars (2022$). Life expectancy with or without T2DM was obtained from a prospective cohort study. One-way and 2-way sensitivity analyses were performed to evaluate the impact of variations in the probability of T2DM resolution following ESG as well as variations of the cost of ESG. Results: Quality-adjusted life-years (QALYs), cost (in 2022$), and incremental cost-effectiveness ratios (ICERs) were calculated. For the 5-year time horizon in patients with T2DM, ESG produced 4.28 QALYs and incurred a total cost of $77,874, compared to 3.99 QALYs and a total cost of $73,738 for no ESG, resulting in an ICER of $13,922 per QALY gained. For the lifetime horizon, ESG produced 29.57 QALYs and incurred a lifetime cost of $451,261, compared to 26.69 QALYs and incurred a lifetime cost of $493,806 for no ESG, resulting in a negative ICER (i.e., cost-saving). The 5-year time horizon in patients without T2DM demonstrated that ESG produced 4.42 QALYs, compared to 4.08 QALYs with no ESG, resulting in an ICER of $39,116 per QALY gained. For the lifetime horizon ESG produced 34.21 QALYs, compared to 31.60 QALYs for no ESG, resulting in an ICER of $4,752. Conclusion: This cost-effectiveness analysis suggests that ESG is cost-effective in 5 years and cost-saving over a lifetime for patients with obesity and type 2 diabetes (Figure). ESG remains cost-effective at 5 years and over a lifetime in patients without T2DM.Figure 1.: Decision Analytic Model Table 1. - Parameters and data sources Parameters Source Endoscopic Sleeve Gastroplasty Cost of ESG (2022$) $12,999 (Institutional data) Cost of Complication of ESG (2022$) $13,851.96 AHRQ (Avg hospital stay) Rate of Complication of ESG 2.2% Hedjoudje et al Annual Medical Costs (2022$) Obese with T2DM, age 40 $14,767.52 Chang et al Obese w/o T2DM age 40 Chang et al Probability of T2DM improvement after ESG 0.19 Wing et al Life expectancies Obese with no T2DM, age 40 38.7 years Leung et al Obese with T2DM, age 40 33.48 years Leung et al, Chang et al Utility weight Obese with T2DM 0.797 Boye et al Obese w/o T2DM 0.817 Boye et al Obese with T2DM, 15% weight loss 0.850 Boye et al Obese w/o T2DM, 15% weight loss 0.884 Boye et al