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Obesity
Cost-effectiveness of endoscopic, surgical and pharmacological obesity therapies: a microsimulation and threshold analyses
  1. Monica Saumoy1,
  2. Devika Gandhi2,
  3. Seth Buller3,
  4. Shae Patel3,
  5. Yecheskel Schneider4,
  6. Gregory Cote5,
  7. Michael L Kochman6,7,
  8. Nikhil R Thiruvengadam2,
  9. Reem Z Sharaiha8
  1. 1 Center for Digestive Health, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA
  2. 2 Department of Gastroenterology and Hepatology, Loma Linda University School of Medicine, Loma Linda, California, USA
  3. 3 Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
  4. 4 Department of Gastroenterology, St Luke’s University Health Network, Bethlehem, Pennsylvania, USA
  5. 5 Department of Gastroenterology, Oregon Health Sciences University, Portland, Oregon, USA
  6. 6 Department of Gastroenterology, Perelman School of Medicine the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  7. 7 Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8 Department of Gastroenterology & Hepatology, Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Dr Reem Z Sharaiha, Gastroenterology & Hepatology, Weill Cornell Medical College, New York, New York, USA; rzs9001{at}med.cornell.edu

Abstract

Objective Weight loss interventions to treat obesity include sleeve gastrectomy (SG), lifestyle intervention (LI), endoscopic sleeve gastroplasty (ESG) and semaglutide. We aimed to identify which treatments are cost-effective and identify requirements for semaglutide to be cost-effective.

Design We developed a semi-Markov microsimulation model to compare the effectiveness of SG, ESG, semaglutide and LI for weight loss in 40 years old with class I/II/III obesity. Extensive one-way sensitivity and threshold analysis were performed to vary cost of treatment strategies and semaglutide adherence rate. Outcome measures were incremental cost-effectiveness ratios (ICERs), with a willingness-to-pay threshold of US$100 000/quality-adjusted life-year (QALY).

Results When strategies were compared with each other, ESG was cost-effective in class I obesity (US$4105/QALY). SG was cost-effective in class II obesity (US$5883/QALY) and class III obesity (US$7821/QALY). In class I/II/III, obesity, SG and ESG were cost-effective compared with LI. However, semaglutide was not cost-effective compared with LI for class I/II/III obesity (ICER US$508 414/QALY, US$420 483/QALY and US$350 637/QALY). For semaglutide to be cost-effective compared with LI, it would have to cost less than US$7462 (class III), US$5847 (class II) or US$5149 (class I) annually. For semaglutide to be cost-effective when compared with ESG, it would have to cost less than US$1879 (class III), US$1204 (class II) or US$297 (class I) annually.

Conclusions Cost-effective strategies were: ESG for class I obesity and SG for class II/III obesity. Semaglutide may be cost-effective with substantial cost reduction. Given potentially higher utilisation rates with pharmacotherapy, semaglutide may provide the largest reduction in obesity-related mortality.

  • obesity
  • gastrointestinal surgery
  • gastrectomy

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/gutjnl-2023-330437

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • NRT and RZS contributed equally.

    • Correction notice This article has been corrected since it published Online First. The author affiliations have been updated.

    • Contributors NRT, MS and RZS designed the study, NRT, SB, DG, SP and MS acquired the data, NRT and MS analysed the data, NRT and MS interpreted the data and performed the statistical analysis. NRT, DG, MS and RZS wrote the manuscript. SB, YS, GC, LA, SP and MLK helped revise the manuscript. All authors discussed the data and the analysis methods and contributed to the manuscript. RZS and NRT accept full responsibility for the work and conduct of the study, had access to the data and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MLK: consultant: ACI, AGA-Varia, BSC, Dark Canyon Labs, Endiatx, Medtronic, Olympus, Virgo Systems; equity: AGA-Varia, Dark Canyon Labs, Endiatx, EndoSound, Virgo Systems. RZS: consultant for BSC, Cook Medical, Surgical Intuitive and Olympus America. The rest of the authors have no conflicts to disclose.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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