The surgical treatment of type 2 diabetes: economic evaluation

Aim To evaluate the clinical and cost-effectiveness of the laparoscopic Roux-en-Y gastric-bypass (LRYGB) in obese patients with type 2 diabetes. Tasks: 1. To investigate all the patients underwent the LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 2. To compare the clinical outcomes and quality of life (QoL) in operated patients before and 1 year or later after the surgery. 3. To evaluate the cost-effectiveness of LRYGB and to compare it with the conventional treatment cost. Methodology of the research The retrospective study of 51 patient underwent LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. The clinical evaluation of operated patients 1 year or later after the laparoscopic gastric-bypass. SF-36 questionnaire and SF-6D conversion model were used to evaluate the QoL and health benefits after the surgery. To evaluate and to compare the surgical and conventional treatment costs in obese type 2 diabetes patients, the cost utility analysis model was used. Kaunas regional committee of bioethics approved the project (permission Nr BE-2-59). The data was processed and analysed using the package SPSS 15,0 of statistical data analysis. Results 76 patients (52 women and 24 men) were operated on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010. 67 patients underwent LRYGB, in 8 patients the laparoscopic adjustable gastric banding and sleeve resection in 1 patient were performed. One year or later after the surgery 51 (81%) of LRYGB patients arrived for precise investigation. The mean age of the investigated patients was 52 ± 5.7 years (range, 18-71). The weight and body mass index (BMI) significantly decreased after the surgery, from 149.3 ± 31.3 kg (range, 100-260) to 99.3 ± 18.3 kg (range, 60-150) and from 51.8 ± 8.7 kg/m2 (range; 34.4 – 81.1) to 34.7 ± 6.6 kg/m2 (range, 23.6 – 46.8), respectively (p<0.0001). Glycated haemoglobin (HbA1с) decreased after the surgery from 8.1 ± 1.7% (range, 5.5 – 12.1) to 5.9 ± 0.6 (range, 4.4 – 7.1), (p<0.0001). The fasting glycemia also decreased after the LRYGB from 8.7 ± 2.8 mmol/l (range, 5.9 – 14) to 5.4 ± 0.9 mmol/l (range, 4.2 – 7.1), (p<0.0001). The requirement of anti-pressure medicaments decreased in number and dosage of drugs, (p<0.001). We also found the decrease of serum cholesterol levels in investigated patients: total cholesterol concentration decreased from 5.9 mmol/l to 5 mmol/l, (p=0.002), low density lipoprotein (LDL) cholesterol from 3.72 mmol/l to 2.9 mmol/l, (p=0.02), triglycerides from 2.78 mmol/l to 1.41 mmol/l, (p=0.001). Whereas the level of ‘‘good‘‘ – high density lipoprotein (HDL) cholesterol increased, (p=0.09). Physical components of QoL improved in operated patients (p<0.05). Beck depression inventory revealed the mean of 11.2±9.2 after the operation, accordingly to mild depression level. We found the remission of type 2 diabetes in 23 (45.1%) of investigated patients. In the rest patients we observed the significant reduction of all anti-diabetic drugs dosage (p<0.001). We calculated the direct cost of surgical treatment of these obese type 2 diabetes patients as 16 592Lt/10 years and 25 611Lt/10 years in non-operated. In addition with indirect costs operative treatment would be cheaper in these patients, e.g. 21 720Lt/10 years and 51 222Lt/10 years, respectively. The incremental cost-effectiveness ratio of LRYGB in obese type 2 diabetes patients is -4214.5 Lt/QALY. Conclusions 51 (81%) patient that underwent LRYGB on obesity and type 2 diabetes in LUHS Kaunas Hospital in 2005-2010 were investigated 1 year or later after the surgery. We found the remission of type 2 diabetes in 45.1% of investigated patients. In the rest patients we observed the significant reduction of all anti-diabetic and anti-pressure drugs dosage (p