Options in Bariatric Surgery: Modeled Decision Analysis Supports One-Anastomosis Gastric Bypass as the Treatment of Choi
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Options in Bariatric Surgery: Modeled Decision Analysis Supports One-Anastomosis Gastric Bypass as the Treatment of Choice when Type 2 Diabetes Is Present Conor Brosnan 1,2 & Jarlath C. Bolger 1,2 & Eamonn M. Bolger 1,2 & Michael E. Kelly 1,2 & Roisin Tully 1,2 & Mohamed AlAzzawi 1,2 & William B. Robb 1,2 Received: 14 May 2020 / Revised: 11 August 2020 / Accepted: 11 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Obesity and type 2 diabetes mellitus (T2DM) represent significant healthcare burdens. Surgical management is superior to traditional medical therapy. Laparoscopic sleeve gastrectomy (LSG) and gastric bypass (both Roux-en-Y (RYGB) and one anastomosis gastric bypass (OAGB) are the most commonly performed metabolic procedures. It remains unclear which gives the optimal quality-of-life pay-off in the context of T2DM. This study compares LSG, RYGB, and OAGB in the management of T2DM and obesity using modeled decision analysis. Alternative approaches were assessed considering efficacy of interventions, post-operative complications, and quality of life outcomes to determine the optimal approach. Methods Modeled decision analysis was performed from the patent’s perspective comparing best medical management (MM), SG, RYGB, OAGB, and LAGB. The base case is a 40-year-old female with a body mass index (BMI) of 40 and T2DM. Input variables were calculated based on published decision analyses and a literature review. Utilities were based on previous studies. Sensitivity analysis was performed. The payoff was quality-adjusted life years (QALYs) 5 years from intervention. TreeAge Pro modeling software was used for analysis. Results In 5-years post-procedure, OAGB gave the optimal QALY payoff of 3.65 QALYs (reviewer 2). RYGB gave 3.47, SG gave 3.08, LAGB gave 2.62 and MM 2.45 QALYs. Three input variables proved sensitive. RYGB is optimal if its metabolic improvement rates exceed 86%. It is also optimal if metabolic improvement rates in OAGB drop below 71.8% or if the utility of OAGB drops below 0.759. Conclusion OAGB gives the optimal QALY payoff in treatment of T2DM. RYGB and SG also improve metabolic outcomes and remain viable options in selected patients. Keywords Modeled decision analysis . Obesity . Type 2 diabetes
Introduction Diabetes mellitus refers to a group of metabolic diseases characterized by persistent hyperglycemia resulting from defects in insulin secretion, action, or both [1]. Type 2 diabetes mellitus Conor Brosnan and Jarlath C. Bolger contributed equally to this work. * Conor Brosnan [email protected] 1
Department of Upper GI Surgery, Beaumont Hospital, Beaumont, Dublin 9, Republic of Ireland
2
Department of Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland
(T2DM) is the commonest form, accounting for 90–95% of all cases [2]. Studies estimate a global health burden of $1.3 trillion per annum, with economic strain affecting both developed and developing countries [3, 4]. T2DM is a well-known cause for r
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