BEYOND COST-EFFECTIVENESS: PROVIDER-LEVEL SUSTAINABILITY OF ENDOSCOPIC SLEEVE GASTROPLASTY IN SPANISH PRIVATE HOSPITALS
Author(s)
Manikanta Dasari1, Shreya Bhuiya, M.Sc.1, Varun Ektare, MPH2, ANA BATANERO, MBA, MSc3.
1Indence Research Private Limited, Kolkata, India, 2Indence Research Private Limited, Thane West, India, 3BOSTON SCIENTIFIC, Madrid, Spain.
1Indence Research Private Limited, Kolkata, India, 2Indence Research Private Limited, Thane West, India, 3BOSTON SCIENTIFIC, Madrid, Spain.
OBJECTIVES: Health-economic evaluation typically asks whether an intervention is cost-effective for payers, while provider sustainability is less often formalised. This analysis assessed the provider-level economics of endoscopic sleeve gastroplasty (ESG) in a Spanish private-hospital setting, including per-case costs, gross profit, and gross margin.
METHODS: A per-case cost and gross-margin model was developed from the private-provider perspective, incorporating pre-procedural workup, the procedure-day costs (device, staff time, anaesthesia, medication, consumables), adverse events (AEs), reinterventions (RIs), and bundled follow-up, including nutrition, physician, and allied-specialist visits. Inputs used Spanish tariffs and published evidence. The midpoint of a procurement range was used as the base-case device cost. Outputs included cost structure, gross margin, 5-year profit-and-loss under volume ramp-up, and cumulative gross profit. Scenario analyses varied device cost, bundled follow-up duration (no follow-up, 1-year, 2-year), volume-based discounts, and procedure-time learning-curve effects.
RESULTS: ESG generated positive provider economics across all scenarios, with gross margins of 15%-28% across the device-cost range and 21% in the base case. Device cost was the largest single per-case component (47%), followed by bundled follow-up (17%). AE and RI costs represented approximately 5% of per-case cost. Follow-up duration was a program-design driver: no follow-up versus a 2-year bundled follow-up changed gross margin by 14 percentage points. Under a 5-year volume ramp-up from 15 to 100 annual cases (270 cumulative), procedure-time efficiency and volume-based discounts increased adjusted annual gross margin from 21% (year-1) to 26% (year-5), and cumulative gross profit by 15% relative to the base case.
CONCLUSIONS: ESG demonstrated favourable provider-level economics in a Spanish private-hospital setting, with positive gross margins across all scenarios. Provider-level financial sustainability was driven by device cost, follow-up design, procedural volume, and procedure-time efficiency. In the era of anti-obesity medications, provider-perspective margin modelling can complement payer-facing economic evaluation by identifying conditions under which endoscopic obesity services remain viable and scalable.
METHODS: A per-case cost and gross-margin model was developed from the private-provider perspective, incorporating pre-procedural workup, the procedure-day costs (device, staff time, anaesthesia, medication, consumables), adverse events (AEs), reinterventions (RIs), and bundled follow-up, including nutrition, physician, and allied-specialist visits. Inputs used Spanish tariffs and published evidence. The midpoint of a procurement range was used as the base-case device cost. Outputs included cost structure, gross margin, 5-year profit-and-loss under volume ramp-up, and cumulative gross profit. Scenario analyses varied device cost, bundled follow-up duration (no follow-up, 1-year, 2-year), volume-based discounts, and procedure-time learning-curve effects.
RESULTS: ESG generated positive provider economics across all scenarios, with gross margins of 15%-28% across the device-cost range and 21% in the base case. Device cost was the largest single per-case component (47%), followed by bundled follow-up (17%). AE and RI costs represented approximately 5% of per-case cost. Follow-up duration was a program-design driver: no follow-up versus a 2-year bundled follow-up changed gross margin by 14 percentage points. Under a 5-year volume ramp-up from 15 to 100 annual cases (270 cumulative), procedure-time efficiency and volume-based discounts increased adjusted annual gross margin from 21% (year-1) to 26% (year-5), and cumulative gross profit by 15% relative to the base case.
CONCLUSIONS: ESG demonstrated favourable provider-level economics in a Spanish private-hospital setting, with positive gross margins across all scenarios. Provider-level financial sustainability was driven by device cost, follow-up design, procedural volume, and procedure-time efficiency. In the era of anti-obesity medications, provider-perspective margin modelling can complement payer-facing economic evaluation by identifying conditions under which endoscopic obesity services remain viable and scalable.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE173
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)