E0607 - Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty

Tuesday, October 25, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Michael G. Daniel, MD

Washington University School of Medicine
St. Louis, VA

Award: Outstanding Research Award in the Obesity Category (Trainee)

Award: Presidential Poster Award

Michael G. Daniel, MD¹, Cassandra D.L.. Fritz, MD, MPHS², Tsehay Abebe, MD³, Ahmad Bazarbashi, MD³, Shelby Sullivan, MD⁴, Su-Hsin Chang, PhD³, Vladimir Kushnir, MD³
¹Washington University School of Medicine, St. Louis, VA; ²Washington University School of Medicine in St. Louis, St. Louis, MO; ³Washington University School of Medicine, St. Louis, MO; ⁴University of Colorado Anschutz Medical Center, Aurora, CO

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. 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 two-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.

Discussion: 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. ESG remains cost-effective at 5 years and over a lifetime in patients without T2DM.

Figure: Decision Analytic Model

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

Table: Parameters and data sources

Disclosures:

Michael Daniel indicated no relevant financial relationships.

Cassandra Fritz indicated no relevant financial relationships.

Tsehay Abebe indicated no relevant financial relationships.

Ahmad Bazarbashi indicated no relevant financial relationships.

Shelby Sullivan: Allurion Technologies – Consultant. Aspire Bariatrics – Grant/Research Support. Elira Therapeutics – Consultant, Stock Options. Endo Tools Therapeutics – Consultant. Finch Therapeutics – Grant/Research Support. Nitinotes Surgical – Consultant. Obalon Therapeutics – Consultant, Grant/Research Support. Phenomix Sciences – Consultant. ReBiotix – Grant/Research Support.

Su-Hsin Chang indicated no relevant financial relationships.

Vladimir Kushnir indicated no relevant financial relationships.

Michael G. Daniel, MD¹, Cassandra D.L.. Fritz, MD, MPHS², Tsehay Abebe, MD³, Ahmad Bazarbashi, MD³, Shelby Sullivan, MD⁴, Su-Hsin Chang, PhD³, Vladimir Kushnir, MD³. E0607 - Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.