Medical treatment is increasingly common for weight loss, with bariatric surgery considered the most effective intervention for morbid obesity. Endoscopic sleeve gastroplasty (ESG) is a recently developed minimally invasive weight loss procedure whereby sutures are placed to reduce stomach volume. The objective of this study is to assess the cost-effectiveness of ESG, compared to traditional surgical alternative of laparoscopic sleeve gastroplasty (LSG).

METHODS

We developed a Markov model with seven states, including five BMI categories (<30; 30-34; 35-39; 40-49; 50-59 kg/m2), one surgical adverse event state, and a death state, to estimate the incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB) of ESG relative to LSG, using a U.S. healthcare perspective, with a lifetime horizon and one-month cycle length. Transition probabilities, costs and utility-weight estimates were derived from the scientific literature and the Health Care Utilization Project (HCUP) database. The model was populated with a cohort of 1,000 individuals (BMI 35-39). Probabilistic sensitivity analyses (PSAs) were conducted with different starting BMI to account for parameter uncertainty.

RESULTS

In the base case and at the average willingness to pay (WTP) threshold of $100,000/QALY gained, LSG strongly dominated ESG (ICER of -$11,816/QALY gained) due to the higher cost and lower effectiveness of ESG compared to LSG. This translated into a NMB of -$38,410. In PSAs, the base case ICER remained robust to parameter uncertainties, with 81.5% of the 1,000 simulated values remaining strongly dominated. The cost-effectiveness profile of ESG relative to LSG did not vary with changes in starting BMI category.

CONCLUSIONS

ESG is not a cost-effective alternative to LSG, driven primarily by higher costs and lower clinical effectiveness. Further studies should compare different surgical and endoscopic options to identify optimal interventions.