Table 2. Cost-effectiveness Results Over 5-Year Time Horizona.
| Category | Medical therapy | Sleeve gastrectomy | Roux-en-Y gastric bypass |
|---|---|---|---|
| Overall | |||
| Costs, mean, $ | 61 620 | 80 254 | 82 253 |
| Incremental costs, mean (95% CI), $ | 1 [Reference] | 18 634 (7861 to 30 988) | 20 633 (10 269 to 32 937) |
| QALY, mean | 3.33 | 3.64 | 3.77 |
| Incremental QALYs, mean (95% CI) | 1 [Reference] | 0.31 (0.13 to 0.66) | 0.44 (0.21 to 0.86) |
| ICER ($/QALY gained)b | 1 [Reference] | Extendedly dominated | 46 877 |
| Probability preferred strategy, %c | 4.9 | 12.1 | 83.0 |
| Mild T2D at baseline | |||
| Costs, mean, $ | 58 949 | 67 244 | 71 059 |
| Incremental costs, mean (95% CI), $ | 1 [Reference] | 8296 (−2416 to 20 809) | 12 111 (2137 to 23 728) |
| QALY, mean | 3.40 | 3.89 | 3.99 |
| Incremental QALYs, mean (95% CI) | 1 [Reference] | 0.49 (0.30 to 0.85) | 0.59 (0.35 to 0.98) |
| ICER ($/QALY gained)b | 1 [Reference] | 16 926 | 36 479 |
| Probability preferred strategy, %c | 0.0 | 26.3 | 73.7 |
| Moderate T2D at baseline | |||
| Costs, mean, $ | 61 271 | 78 550 | 79 841 |
| Incremental costs, mean (95% CI), $ | 1 [Reference] | 17 279 (5873 to 30 351) | 18 570 (7665 to 31 649) |
| QALY, mean | 3.33 | 3.68 | 3.83 |
| Incremental QALYs, mean (95% CI) | 1 [Reference] | 0.35 (0.16 to 0.68) | 0.50 (0.25 to 0.88) |
| ICER ($/QALY gained)b | 1 [Reference] | Extendedly dominated | 37 056 |
| Probability preferred strategy, %c | 0.8 | 13.6 | 85.6 |
| Severe T2D at baseline | |||
| Costs, mean, $ | 63 848 | 90 848 | 93 773 |
| Incremental costs, mean (95% CI), $ | 1 [Reference] | 27 000 (16 754 to 39 870) | 29 925 (18 999 to 42 188) |
| QALY, mean | 3.30 | 3.49 | 3.60 |
| Incremental QALYs, mean (95% CI) | 1 [Reference] | 0.20 (0.03 to 0.56) | 0.30 (0.07 to 0.79) |
| ICER ($/QALY gained)b | 1 [Reference] | Extendedly dominated | 98 940 |
| Probability preferred strategy, %c | 56.8 | 3.0 | 40.2 |
Abbreviations: ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; T2D, type 2 diabetes.
a
All costs are shown in 2020 US dollars.
b
ICERs are calculated using the mean costs and QALYs from the 1000 probabilistic iterations and are referent to the next least costly, nondominated strategy. Extendedly dominated indicates that the strategy gains fewer QALYs and costs more per QALY gained than another strategy, representing inefficient use of resources.
c
Probability of being the preferred strategy is presented at a cost-effectiveness threshold of $100 000 per QALY gained.