Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty

BACKGROUND AND AIMS: Obesity is prevalent in the United States. Endoscopic sleeve gastroplasty (ESG) has been shown to produce effective weight loss and improvement in obesity-related disease. The cost effectiveness of ESG is currently unclear in patients with obesity with and without type 2 diabetes (T2DM). METHODS: A decision analytic model with time horizon of 5 years and lifetime, from a health system's perspective was constructed to compare ESG to no weight loss intervention (no ESG) in patients with obesity aged 35-45 years with a body mass index of ≥30 kg/m² with or without T2DM. Parameters were obtained based on peer-reviewed data. One-way and 2-way sensitivity analyses were performed for variations in T2DM resolution and ESG costs. RESULTS: For the 5-year time horizon in patients with T2DM, ESG produced 4.28 quality-adjusted life years (QALYs) and cost $77,874, compared with 3.99 QALYs and a cost of $73,738 for no ESG, resulting in an incremental cost-effectiveness ratio (ICER) of $13,922 per QALY. For the lifetime horizon, ESG produced 29.57 QALYs and a lifetime cost of $451,261, compared with 26.69 QALYs and a lifetime cost of $493,806 for no ESG, resulting in a negative ICER (ie, cost saving). The 5-year time horizon in patients without T2DM demonstrated that ESG produced 4.42 QALYs, compared with 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 with 31.60 QALYs for no ESG, resulting ICER of $4752. CONCLUSION: 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.