Cost-Effectiveness Analysis of Duodenal–Jejunal Bypass Sleeve Device for People With Obesity

OBJECTIVES: The aim of this study is to conduct economic evaluation of Duodenal–Jejunal Bypass Sleeve (DJBS) plus intensive lifestyle intervention (ILI) compared with ILI in people with obesity in China.

METHODS: A decision tree Markov model was used to compare 9-month and lifetime horizon cost-effectiveness between DJBS plus ILI and ILI. The data of clinical effectiveness were based on a prospective, open-label and randomized trial (NCT05938231). The willingness-to-pay (WTP) threshold was 1~3 times GDP per capita in China (GDP per capita CNY ¥85,498 yuan, 2022). One-way, probabilistic sensitivity and scenario analysis were performed to test the robustness of the results.

RESULTS: The results of 9-month decision tree model showed that compare to ILI, DJBS plus ILI decreased body mass index (BMI) by 1.69 kg/m2 (1.41 vs. 3.10), with increasing cost of CNY ¥28,963.98 yuan (CNY ¥29,111.06 vs. CNY ¥147.08). The incremental cost-effectiveness ratio (ICER) was CNY ¥17,138.45 yuan per unit decrease of BMI. The lifetime horizon model showed that compared to ILI, DJBS plus ILI had a higher cost of CNY ¥13261.94 yuan (CNY ¥ 31,688.98 vs. CNY¥18,427.04), while with life-years increase of 0.02 (9.43 vs. 9.41) and quality-adjusted life years (QALYs) increase of 0.15 (7.82 vs. 7.67) per people with obesity. The ICER was CNY ¥88,412.93 per QALY gained. Probability sensitivity analysis showed the robustness of the economic evaluation results. In addition, the ICER was CNY ¥148,218.00 for DJBS plus ILI compared to bariatric surgery.

CONCLUSIONS: The findings suggested that, compared to ILI, DJBS plus ILI is a cost-effective strategy over the lifetime horizon when the WTP threshold was 1.03 times GDP per capita.