Cost-Efficacy of Surgically Induced Weight Loss for the Management of Type 2 Diabetes

OBJECTIVE — To determine the within-trial cost-efficacy of surgical therapy relative to conventional therapy for achieving remission of recently diagnosed type 2 diabetes in class I and II obese patients. RESEARCH DESIGN ANDMETHODS — Efficacy results were derived from a 2-year randomized controlled trial. A health sector perspective was adopted, and within-trial interven-tion costs included gastric banding surgery, mitigation of complications, outpatient medical consultations, medical investigations, pathology, weight loss therapies, and medication. Re-source use was measured based on data drawn from a trial database and patient medical records and valued based on private hospital costs and government schedules in 2006 Australian dollars (AUD). An incremental cost-effectiveness analysis was undertaken. RESULTS — Mean 2-year intervention costs per patient were 13,400 AUD for surgical ther-apy and 3,400 AUD for conventional therapy, with laparoscopic adjustable gastric band (LAGB) surgery accounting for 85 % of the difference. Outpatient medical consultation costs were three times higher for surgical patients, whereas medication costs were 1.5 times higher for conven-tional patients. The cost differences were primarily in the first 6 months of the trial. Relative t